Computerized system for blood chemistry monitoring

ABSTRACT

An apparatus and computerized method of intravenously monitoring a patient&#39;s blood chemistry transmits real time measurements to an electronically controlled closed loop system that auto-regulates blood osmolality and glucose level with medications infused through a catheter designed for such purpose. The closed loop system utilizes a glucose algorithm and an osmolality algorithm implemented in hardware and software to control the flow of dextrose, insulin and hypertonic saline to a patient in an effort to achieve better patient outcomes in instances of trauma, surgery and medical illnesses.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part of international patentapplication Serial No. PCT/US08/73959 filed on Aug. 22, 2008, andpublished on Mar. 12, 2009, as WO 2009/032553, which is incorporated byreference in its entirety. The predecessor international applicationclaims the benefit of priority based on co-pending U.S. ProvisionalPatent Application Ser. No. 60/969,582 filed in the United States Patentand Trademark Office on Aug. 31, 2007, which is hereby incorporated byreference in its entirety. The international case, as well as thisapplication, also claims the benefit of co-pending U.S. PatentApplication Ser. No. 60/973,891 filed on Sep. 20, 2007, which isincorporated by reference in its entirety.

FIELD OF THE INVENTION

The invention relates to a system of intravenously monitoring apatient's blood chemistry and transmitting real time measurements to anelectronically controlled closed loop system that auto-regulates bloodosmolality and glucose levels with medications infused through a newcatheter design.

BACKGROUND OF THE INVENTION

In clinical medicine, swelling of the brain occurs in several commondisease states such as (1) traumatic brain injury, (2) stroke, (3)survivors of cardiac arrest, (4) meningitis, (5) encephalitis and (6)brain tumors. Other less common conditions can also produce swelling ofthe brain. Physicians currently use several methods to treat both thebrain swelling and the elevated intracranial pressure associated withit. These methodologies include intracranial pressure monitoring,removal of cerebrospinal fluid if an intraventricular catheter is inplace, mechanical ventilation to prevent hypoxia and hypercarbia, strictcontrol of fluid balance to provide for a normal intravascular fluidvolume while avoiding hypo-osmolality, use of osmolar agents to create ahyperosmolar state, elevating the head of the bed, sedation andparalysis as needed. Routine surveillance of the intracranial vault withCT scans of the head is also used to rule out space occupying lesionsthat would be amenable to surgical removal.

Recent studies have also shown that use of hypothermia with bodytemperatures lowered to 32-34 degrees Celsius within 4 hours of theonset of traumatic brain injury¹ or cardiac arrest² can improveneurological outcome.

In addition, uncontrolled hyperglycemia has been shown to adverselyaffect mortality rates in traumatic brain injury³, stroke⁴, and cardiacarrests.

It has also been shown that strict control of blood glucose can improvemortality rates in post-operative patients and in medical ICU patientswho remain in the ICU for at least three days.^(6,7,8,9) Unfortunately,these studies and others¹⁰ have shown that hypoglycemia is acomplication of strict glucose control utilizing an intravenous infusionof insulin.

In another treatment scenario, the continuous monitoring of serumosmolality, as provided by the catheter, will allow tighter control ofserum osmolality, which may also improve neurological outcome inpatients with cerebral edema.¹¹ The iterative algorithm created tocontrol an infusion of hypertonic saline will help clinicians achievethe goal of tight osmolality control.

Prior efforts in biomedical engineering have attempted to addresssimilar goals. One of the earliest attempts at intravenous medicalintervention is set forth in U.S. Pat. No. 4,072,146 (Howes 1978)entitled Venous Catheter Device. The Howes '146 patent discloses acatheter with a plurality of independent and non-communicating fluidconveying lumens housed within or formed in a single catheter. Eachlumen transports a different fluid—or solution for entry into thepatient's bloodstream.

U.S. Pat. No. 4,403,984 (Ash 1983) expands upon the concept ofintravenous infusion and discloses a catheter with sensors for measuringin vivo the physical properties of blood. The signals from the sensorcontrol infusion of medication, such as insulin, in response to aglucose measurement. The Ash '984 catheter measures osmolality viaelectrolytic conductivity of the blood. In one embodiment, Ash uses theosmolality reference signal as the insulin distribution control signal.

A series of patents issued to Schulman and granted as U.S. Pat. Nos.5,497,772; 5,531,679; 5,660,163 show glucose sensors positioned within apatient's bloodstream for glucose and oxygen monitoring purposes.Schulman, however, does not show any in-depth means of adjusting glucosein a controlled process.

In determining blood conductivity, noted as useful in the Ash '984patent above, U.S. Pat. No. 5,827,192 (Gopakumaran 1998) discloses an invivo method of determining blood conductivity within the patient'sheart. By utilizing spaced electrodes on a catheter, the Gopakumaranpatent shows that blood conductivity can be determined from an inducedvoltage from a known current.

Still, however, none of the patents discussed above utilize a trulyclosed loop process for measuring multiple parameters, such asconductivity, osmolality, and glucose concentration, to adjust bloodchemistry via infusions of multiple medicines or fluids. In regard tothe osmolality measurements described herein, a conductivity sensor suchas that of U.S. Pat. No. 4,380,237 (Newbower 1983) is available toprovide blood conductivity measurements. Newbower, however, is limitedin its disclosure to cardiac measurements that do not focus on glucoseor osmolality readings. The Newbower '237 patent, then is limited in itsdisclosure.

The only known patent that even broaches the topic of a multi-variableclosed loop system is U.S. Pat. No. 6,740,072 (Starkweather 2004). TheStarkweather '072 patent discloses a system and method of providingclosed loop infusion delivery systems that determine the volume of aninfused substance via a sensed biological parameter. The Starkweather'072 controller is a multiple input single output controller using aproportional component and a derivative component of blood glucosemeasurements. The proportional component is simply the differencebetween the measured glucose level and the desired set point. Thederivative component shows the rate of change for real time glucoselevel measurements. An appropriate controller then adjusts the singleoutput-insulin dose. Starkweather, however, is limited in its ability toaccount for nonlinear physiological responses such as blood levels forglucose and osmolality. Specifically, in hypoglycemic states theStarkweather controller's only response is to lower or stop the insulininfusion. It does not include any active interventions to raise theblood glucose level such as initiation of a glucagon infusion in theoutpatient setting, or initiation of a glucagon or dextrose infusion inthe inpatient setting.

Even in light of the above noted developments, there continues to be aneed in the art of blood chemistry intervention for a means ofmonitoring and controlling nonlinear physiological responses in theblood stream. In particular, there is a need for a closed loop systemthat successfully adjusts blood chemistry parameters, including but notlimited to glucose and osmolality, in real time emergency andnon-emergency settings.

To accomplish these and other goals of the invention, the apparatus andsystem disclosed herein provide a means for closed loop electronicmonitoring and blood chemistry regulation.

BRIEF SUMMARY OF THE INVENTION

A computerized glucose adjustment system intravenously controls apatient's blood chemistry on a real time basis. The system encompasseshardware including a catheter placed within the patient's vascularsystem, a glucose sensor attached to the catheter and in contact withthe patient's bloodstream, and a pump connected to a source of insulinand a source of dextrose for distributing insulin and dextrose into apatient's bloodstream through the catheter. A computer processor is inelectronic communication with the sensor and the pump such that theprocessor receives an electronic signal from the sensor to calculate thepatient's real time average blood glucose level over a specified timeperiod. A glucose control module stored in the processor sends outputsignals to the pump for controlling the rate at which the pumpdistributes insulin and dextrose into the patient. The glucose controlmodule incorporates pump controlling commands to (i) determine where thepatient's real time average blood glucose level lies along a continuumof glucose values; (ii) track the rate at which the average bloodglucose level is changing over time; and (iii) iteratively adjust thedextrose flow rate and insulin flow rate into the patient's body toadjust the average glucose level closer to a known normal glucose range.

In one embodiment, the dextrose and insulin flow rates are functions ofthe patient's weight. The glucose control module adjusts pump output byanalyzing current glucose readings in relation to set ranges programmedinto the control module, which allows user input for customizing ranges.The system calculates the rate at which the average glucose levelchanges from one of said specified time periods to the next anddetermines an insulin flow rate adjustment factor and a dextrose flowrate adjustment factor. The adjustment factors allow the pump to changeinsulin and dextrose flow rates to stabilize glucose levels in thepatient toward a desired normal value.

The system may further include a blood osmolality adjustment system forintravenously controlling a patient's blood osmolality on a real timebasis. In this embodiment, the system includes a catheter placed withinthe patient's vascular system, a conductivity sensor assembly attachedto said catheter and in direct contact with the patient's bloodstream, apump connected to a fluid source for infusing the fluid into a patient'sbloodstream through the catheter, and a computer processor in electroniccommunication with the blood conductivity sensor assembly. The computerprocessor converts blood conductivity into an osmolality measurement.The processor is also in electronic communication with an associatedfluid pump. A fluid infusion control module stored in the processorcontrols the pumped fluid flow rate. The fluid infusion control modulecomprises pump controlling commands to (i) determine where the patient'sreal time average osmolality lies along a continuum of osmolalityvalues; (ii) track the rate at which the blood osmolality is changingover time; and (iii) iteratively adjust the pump output so that thefluid flow rate into the patient's body adjusts the average osmolalitylevel closer to a known normal range. In one embodiment, the fluid ishypertonic saline. The system controls pump output by assigning acurrent average blood osmolality value to ranges along a continuum. Thesystem iteratively adjusts flow rates pursuant to previously establishedinstructions for each range.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 schematically depicts a side view of the catheter according tothe present invention and shows the multi-lumen interior through acut-out view.

FIG. 2 is an overview schematic of the catheter including lumen portsand sensors.

FIG. 3 is a cross section view of the catheter of FIG. 2.

FIG. 4 shows the catheter according to this invention installed in itsmeasuring/dispensing state and connected to the closed loop bloodchemistry regulation system.

FIG. 5 shows a first screen available on a monitor included in theclosed loop system along with alarms within the monitor.

FIG. 6 shows a screen available on a monitor included in the closed loopsystem.

FIG. 7 is a plot of glucose levels over time for the protocol describedherein as compared to other published protocols for real time glucosemanagement.

FIG. 8 is a plot of insulin flow rate over time as compared to otherpublished protocols for real time glucose management.

FIG. 9 is a plot of glucose levels over time when the protocol disclosedherein is used at varying time intervals.

FIG. 10 is a plot of insulin flow rate over time when the protocoldisclosed herein is used at varying time intervals.

DETAILED DESCRIPTION Overview

The method, system, and computer program product of this inventionpresent a comprehensive algorithm, implemented via a computerizedcontrol system, for stabilizing a human's blood chemistry. While thefeatures presented here are often described in terms of in-patienthospital medical procedures, the method and apparatus embodiments arenot limited to any particular medical setting. The iterative method ofthis invention may utilize fuzzy logic mathematics¹² for greateraccuracy in modifying infusion rates into the bloodstream.

The algorithms implemented by the computer program product set forthherein are set forth in the attached appendices. Tables A-D areincorporated by reference into this Detailed Description and representrespective embodiments of the control algorithms that adjust a patient'sblood chemistry on a real time basis.

The blood chemistry predominantly at issue in this invention includes,but is not necessarily limited to, values for blood glucose and bloodosmolality levels. In the glucose adjustment algorithm of this inventionboth an insulin infusion and a high dextrose infusion can be used tolower the likelihood of glycemic abnormalities. As it repeats itselfover a specified time period and utilizes a closed loop control system,the algorithm responds to changes in blood chemistry values in a fashionsimilar to the normal human body's own pancreas and liver.

Specifically, the glucose algorithm, also referred to as a computerizedglucose adjustment system, increases the insulin infusion in states ofhyperglycaemia, or increasing glucose. In states of hypoglycemia, ordecreasing glucose, it lowers the insulin infusion and starts a highdextrose infusion. The infusion rate changes can be sudden or gradualdepending on the real time measurements coming from the sensors (20, 23,24) on the catheter (10) placed in the patient's blood stream. Thecontrol loop system is sufficiently automated to lessen the workrequired by a bedside nurse to achieve strict glucose control. Thealgorithm and associated computerized process for controlling bloodchemistry in a medical setting will save not only lives but also healthcare resources.¹³

Referring to FIG. 1, an intravascular catheter (10) includes a pluralityof lumens (13, 14, 15) designed for placement in a patient's vascularsystem, often the central venous system. Two or more lumens allow foradministering intravenous fluids (e.g., electrolytes, nutrients, andmedicine) and monitoring of the central venous pressure via a transducerconnected to one of these lumens. As shown in FIG. 4, in one embodiment,the lumens (13, 14, 15) are connected to four intravenously administeredfluid sources, which may include standard maintenance fluid (44), aninsulin source (45), a dextrose source (46), and a source of hypertonicsaline (47). The intravascular catheter (10) also contains the followingthree components: (i) a thermistor (23) for continuous real timetemperature monitoring, (ii) a glucose sensor (24) for continuous realtime blood glucose level monitoring, and (iii) a conductivity cell (20),(with each electrode shown individually in FIG. 1 as 20A, 20B, 20C, and20D) for continuous real time measurement of the blood's electricalconductivity. Each of the sensors (20, 23, 24) are known in the medicalarts individually and can be implemented via standard equipment.

By using the computerized method of this invention, the electricalconductivity measurements from electrodes 20A to 20D can be converted toosmolality by using the formula:

Serum osmolality=18.95 mOsm/mSiemen×(measured conductivity (mSiemen)).

The apertures (17, 18, and 19) of the plurality of lumens (13, 14, 15)may be located along the distal end of the intravascular catheter (10)with the most distal aperture (19) being at the farthest point into thevein. The proximal portions of the plurality of lumens (13, 14, 15) maybe separate hollow tubes with proximal ends (26, 27, 28) that can beconnected to standard intravenous tubing.

The three measuring components (20, 23, 24) electronically transmittheir respective values to an electronic control system (35) (i.e.,software and hardware programmed to accept and utilize this data). Theelectronic control system (35) may be integrally connected to hardwareand software that implements algorithms for controlling fluid andmedicine administration in the closed loop system. In this regard, theterm “electronic control system” includes a computerized glucoseadjustment system (“the glucose control module” (36)), a computerizedosmolality adjustment system (“the osmolality control module” (38)),maintenance fluid commands, and electronic control hardware(“controllers” and/or “processors” (37)). The closed loop control system(35) maintains the readings on an associated monitor (30) that includesalarms for alerting medical personnel to a patient's blood chemistryfluctuation.

The monitor (30) according to this invention includes, but is notlimited to, readings for blood temperature, blood osmolality, bloodglucose level, and trends for all of these. The monitor may further showtrends for dextrose flow rate, insulin flow rate, and hypertonic salineflow rate. As in typical bedside equipment, the monitor of thisinvention will have an on/off button, a calibration mode, and arrows toadjust monitor readings, just to name a few features.

The monitor (30) includes a plurality of displays including temperaturewith a range of 30° C. to 42° C. or 86° F. to 107.6° F., serumosmolality with a range of 240 to 380 mOsm/Kg and blood glucose with arange of 40 mg/dL to 400 mg/dL. Each measurement has a high and lowalarm on the monitor, which is controlled by the programmable system.

In one embodiment, the osmolality and glucose measurements may becalibrated against the same measurements carried out on blood drawn fromthe patient. In the case of the glucose calibration, this calibrationwill be carried out at least every six hours. The blood for thiscalibration will come from either a finger-stick capillary sample, orcentral venous/arterial line sample. If the sample comes from anin-dwelling line, an amount of blood in sufficient quantity to clear thedead space of the line must be removed prior to obtaining the actualsample. In any case, the blood sample will be processed by a typicalbedside glucose meter, bedside YSI glucose meter, or the hospital'scentral laboratory. After determining the glucose level of the bloodsample the glucose meter will transmit this value along with the timethe sample was taken to the intravenous pump at the bedside. Thistransfer of information from the glucose meter to the intravenous pumpwill occur via either infrared or wireless technology with theintravenous pump having an appropriate infrared sensor or wirelesssensor to receive this information. For purposes of calibration, theglucose value and time of sample may also be manually entered into theintravenous pump. Each of the blood factors being measured-temperature,glucose level, and osmolality—provide significantly better patientoutcomes when monitored closely and efficiently. The portable bedsidemonitor which is part of the intravenous pump assembly will be capableof exporting the temperature, glucose and osmolality values to the fixedbedside monitor which may or may not be part of a hospitals mainframecomputer system. This transfer of information will occur via either awire cable extending from the intravenous pump to the bedside monitor,or via wireless technology. Other important elements of patient caresuch as hourly fluid rates and hourly medication rates may also beexported from the portable bedside monitor to the fixed bedside monitoror hospital mainframe computer system. This exportation of data mayoccur via an electronic cable or via wireless technology. In addition,the temperature measurement will be capable of being exported to otherbedside devices for purposes of controlling the patient's temperature.

In another method of calibrating the system, the nurse could use afinger prick capillary sample in a bedside glucose meter. After readingthe patient's current glucose level, the nurse would have the ability tomanually calibrate the system with data entry. In a meter with an evenhigher level of automation, the bedside glucose meter could read theglucose level from the finger prick sample and then wirelessly transmitthe patient's current glucose reading to the processors for automaticsystem calibration.

The electronic control system (35-38) receives real time data from thesensors on the catheter (10). The electronic control system presentedherein, which includes standard programmable computer processors (37),uses known data transmission techniques along with a new control systemalgorithm (described herein) to maintain and regulate peripheral bedsidedevices. As shown in FIG. 4, the controller can regulate a four channelintravenous pump (40) to maintain the total hourly rate at which fluidsand medications (44-47) are administered through the catheter (10).

The electronic control system (35-37) includes a computerized method ofutilizing the patient's temperature, osmolality, and glucose data, asretrieved from real-time blood stream measurements, to control fluid andmedication (44-47) infusion rates. The computerized method, claimedherein, uses the measured blood chemistry values with known standards ofcare to automate the fluid and medicine infusion process that iscurrently managed manually by medical personnel. In particular, thecomputerized method adjusts the flow rate of dextrose and insulinaccording to the data from the glucose sensor; it further adjustshypertonic saline flow in response to osmolality readings.

The system described herein employs statistical methodologies toeliminate the values that exceed two standard deviations from the mean,thus excluding outlying values. A running average for the physiologicalparameter at issue minimizes the effect of short term oscillations ofdata. The algorithms serving as the basis for the computerized method ofthis invention are attached as two Appendices-one for the glucosecontrol algorithm and one for the osmolality control algorithm.

Glucose Embodiment

In a first embodiment, the control loop of this invention implements acomputerized glucose adjustment system for intravenously controlling apatient's blood chemistry on a real time basis. A catheter (10) isplaced within the patient's vascular system, often within the centralvenous system. The catheter (10) includes a glucose sensor (24) that iscurrently known within the art as having the capability to measure apatient's blood glucose level and transmit that information back to acentral computer processor^(14,15) (37). The system described hereinalso encompasses the use of a subcutaneous glucose monitor that measuresthe patient's glucose level from the tissue just under the skin. Thesystem described herein also encompasses the use of an extracorporealglucose sensor that measures a patient's glucose level on blood that isautomatically and repetitively withdrawn from the patient's body via anindwelling vascular catheter. The computerized system incorporates apump (40) connected, at a minimum, to a source of insulin (45) and asource of dextrose (46) for distributing insulin and dextrose into apatient's bloodstream through the catheter.

A computer processor (37) receives the blood glucose level from theglucose sensor attached to the catheter (10). The computer processor(37) is in electronic communication with both the sensor (24) and thepump (40) to use the glucose measurement to control pump output. Uponreceiving the glucose measurement signal, the computer processor (37)calculates the patient's real-time average blood glucose level over thespecified time period.

A glucose control module (36) stored in the computer processor (37)utilizes input glucose measurements to create output signals. Theglucose control module (36) sends the output to the pump (40) forcontrolling the rate at which the pump (40) distributes insulin anddextrose into the patient. The glucose control module includes pumpcontrolling commands programmed therein. This control module implementssoftware to (i) determine where the patient's real-time average bloodglucose level (“Xa”) lies along a continuum of glucose values; (ii)track the rate at which the average blood glucose level is changing overtime; and (iii) iteratively adjust the weight based dextrose flow rateand weight based insulin flow rate into the patient's body to adjust theaverage glucose level closer to a user specified normal glucose range.

Although infusing insulin (45) and dextrose (46) into patients has beenknown for years, utilizing controlled insulin and dextrose flow rates,particularly those calculated as a function of the patient's weight inkilograms, offers added functionality to a closed loop glucosemanagement and adjustment system.

Implementing the computer-controlled glucose adjustment system hereinmay begin by programming the processor to accept as an input the initialconcentration of the dextrose being infused into the patient. Typicallythe dextrose formulation has a concentration selected from the groupconsisting of 5, 10, 12.5, 15, 20, and 25 in percent weight per volume.The insulin formulation will also be a known concentration measured inInternational Units (IU)/mL. The typical concentration used at this timeis 1 IU/mL.

The computerized glucose adjustment system, which operates continuouslyon a real time basis, iteratively receives glucose measurements from theglucose sensor (24) on the catheter (10), analyzes these measurements,calculates the average glucose level over a specified time period, andsends an output signal to the pump (10) managing dextrose (46) andinsulin (45) infusion. To ensure that the glucose adjustment system (36)described herein performs in optimal fashion, the system is capable ofallowing a user to set a known normal glucose range between Xmin andXmax. This range becomes the target that the computerized glucoseadjustment system seeks to achieve in real-time blood glucosemeasurements.

As a first step in reaching blood glucose levels within the selectedrange, the glucose control module (36) calculates and stores inappropriate mathematical units (typically milligrams per decilitre) anaverage blood glucose level Xa for a specified time period. For example,the glucose control module may calculate and store a “current” bloodglucose value Xt (i.e., glucose sensor measurement at time t) inmilligrams per deciliter every 30 seconds and then calculate the averageglucose level Xa in milligrams per deciliter over a specified timeperiod (e.g. 10 minutes). In other words, the glucose adjustment systemkeeps a running average of the blood glucose level as measured by thecatheter's glucose sensor (24) in the patient's bloodstream. At anygiven time, the controller (37) has available to it the average bloodglucose level for the previous 10 minutes, or whatever time period hasbeen selected by the user. This 10 minute average glucose value islabelled as Xa. In addition the computer processor, or controller (37),has available to it the running glucose average for the period prior tothe just completed 10 minute period, or whatever time period has beenselected by the user. This value is noted as Xb. In addition thecomputer processor, or controller (37), has available to it the runningglucose average for the period just prior to Xb. This value is noted asXc.

The control loop operates via a series of pump controlling commands onthe processor (37) that determine the flow rate of insulin (45) anddextrose (46) into the patient. The pump controlling commands aredivided into categories defined by glucose control ranges along thecontinuum of glucose values. The glucose adjustment system definedherein involves the glucose control module (36) calculating which of thepump controlling command categories is appropriate for a particularaverage blood glucose value (Xa). In other words, as the glucose sensor(24) on the catheter (10) transmits a current blood glucose value backto the computer processor (37), the processor stores this value, andwhen all values for the specified time period have been stored, theprocessor electronically calculates the average blood glucose value (Xa)for this time period. The processor then assigns the average bloodglucose value (Xa) to a category of pump controlling commands.

The pump controlling command categories are further divided into groupsdetermined by the amount which the current average blood glucose valuethat has just been calculated (Xa) differs from the user set range ofXmin to Xmax.

The next step in the algorithm implemented by the computerized system isfor the glucose control module (36) to compare the current averageglucose measurement (Xa) to the prior average glucose measurement (Xb).This calculation determines the rate at which the average glucose levelis changing between measurements. In one embodiment of this invention,the time between glucose measurements can be set by the user.

The system intelligently groups real-time human physiological parametersand determines the appropriate command or electronic signal that directsthe pump output (i.e., the amount of insulin and dextrose infused intothe patient.) The glucose adjustment system, including the glucosecontrol module (36), directs pump controlling commands for adjustingpump output. The pump controlling commands direct the pump (not shown)to control the flow rates of insulin (45) and dextrose (46) according tothe category in which the most recent average glucose calculation fitsand the rate at which the glucose level is changing.

For example, the pump controlling commands depend, at least in part,upon the following conditions: (i) the amount the average blood glucoselevel (Xa) differs from a known or desirable normal range between Xminand Xmax, (ii) the amount the average blood glucose level (Xa) haschanged from a previously calculated value (Xb), (iii) the amount theaverage blood glucose value (Xa) has changed from the glucose value Xc,(iv) the known weight-based flow rates of insulin (Insfp) and dextrose(Dexfp) effective at the time the glucose measurement was taken, and (v)the time interval between Xa and Xb, and the time interval between Xaand Xc. Using these factors, the algorithm implemented herein determineshow the insulin and dextrose flow rates from the pump should beincreased or decreased to optimize the real-time blood glucose value(Xt) for the patient at issue.

Stated differently, the algorithm of this invention utilizes a bloodglucose value transmitted from a glucose sensor (24) on an intravenouscatheter (10) to the computerized glucose adjustment system. The glucosesensor (24) transmits real-time blood glucose measurements taken in vivofor the patient at hand. In one embodiment, the computer processor (37)is programmed to receive glucose sensor measurements at a specified timeinterval, such as every 30 seconds.

Once the average blood glucose level Xa has been calculated for aselected time period and the appropriate pump controlling command setdetermined, the computer processor turns to the steps involved indirecting pump (40) output. As part of the glucose control module, therates of insulin and dextrose infusion are maintained in electronicformat for use by the controller. A medical professional sets initialvalues for insulin flow and dextrose flow. In the computer processor,these values would be the first values used for “previous” insulin anddextrose flow rates, referred to herein as Insfp and Dexfp respectively.Over each glucose measurement iteration, the processor uses the averageblood glucose value Xa, the difference between (Xa) and the prioraverage glucose value (Xb), along with the most recent pump state forInsfp and Dexfp to determine how to calculate an updated pump commandfor the “next” insulin and dextrose flow rates, Insfn and Dexfn. In theinitial run through the glucose control algorithm, the value of Xb isset equal to the measured value of Xa, such that: Xa−Xb=0.

In one embodiment of this invention, the pump controlling commandsadjust the insulin (45) and dextrose (46) flow rates going into thepatient as a function of the patient's weight in kilograms (Wt). Forinsulin flow, the pump controlling commands use a multiplier, such as avalue between 0 and 1.7, times the prior insulin flow rate to determinethe extent to which the weight-based insulin flow rate should bechanged. For dextrose flow, the pump controlling commands include, butare not limited to, using flow rate multipliers divided by the initialdextrose concentration (C) value set by the medical professional andmultiplied by the patient's weight in kilograms (Wt). These insulin anddextrose flow rate calculations determine which of several flow rateadjustment factors can be used and converted to pump controlling commandoutput signals. As noted above, the pump controlling commands direct thepump to change the infusion flow rate for the respective insulin and/ordextrose. The pump used in this embodiment can be any one of a number ofstandard multi-channel pumps known in the industry. In a preferredembodiment, the pump is capable of controlling fluid flow rates with anaccuracy down to one tenth of a millilitre per hour.

To further assist the medical professional in monitoring a patient, thesystem includes software for setting high and low alarm set points forglucose values, insulin and dextrose flow, and for differentials betweenconsecutive glucose measurements. For example and without limiting theinvention, a nurse tending a patient might set the low glucose alarm at60 mg/dL, and the high glucose alarm at 240 mg/dL. Similarly, thecontroller can activate an alarm if the differential between the currentaverage glucose value Xa and immediately prior average glucose value Xbis greater than 25 or less than −25 mg/dL. Where these kinds of glucosechanges previously required drawn blood, lab work, and nurse orphysician review, the system of this invention makes the information andalarm almost immediately available for attention.

Another way of describing the glucose adjustment embodiment of thisinvention is in terms of the method of using insulin and dextrose flowrate adjustment factors to optimize glucose levels. As set forth herein,a computerized method of adjusting a patient's blood chemistry on a realtime basis includes adjusting the patient's average glucose level towarda user-specified normal range by multiplying a currently knownweight-based insulin flow rate and a currently known weight-baseddextrose flow rate by adjustment factors. The adjusted flow ratescontrol the amount of insulin and dextrose pumped into a patient'sbloodstream. The method of this invention begins by continuouslymeasuring the patient's real time glucose level, storing each real timeglucose level in a computer processor, and calculating via a computerprocessor an average glucose level, Xa, over a specified time period.

The method further includes electronically assigning the average glucoselevel to one of a series of glucose control ranges. By calculating therate at which the average glucose level changes from one specified timeperiod to the next, the method determines the insulin flow rateadjustment factor and the dextrose flow rate adjustment factor necessaryto achieve a normal glucose range as specified by the bedside clinician.

The insulin flow rate adjustment factor and the dextrose flow rateadjustment factor depend upon the state of the respective weight-basedinsulin and dextrose flow rates already in effect for the patient athand. The adjustment factors are not static numbers that remain the samefor every patient, but rather, the adjustment factors generally dependupon the difference between the measured glucose level and the desiredrange, the rate of change of the glucose level from one time period tothe next, and the previous weight-based flow rates of insulin anddextrose. For example, and without limiting the invention, one usefulcalculation in adjusting insulin flow rate involves comparing theprevious insulin flow rate to a patient's weight in kilograms (Wt). Inthis embodiment, the next insulin flow rate (Insfn) depends upon where,along a range of weight-based flow rates, the previous insulin flow rate(Insfp) falls. The next dextrose flow rate (Dexfn) depends upon where,along a range of weight-based flow rates, the previous dextrose flowrate (Dexfp) falls. In addition, other factors such as the differencebetween the measured glucose level and the desired range, the rate ofchange of the glucose level from one time period to the next and theprior weight-based flow rates of insulin and dextrose are taken intoaccount. In order to account for differences in dextrose concentrationsused, the inverse of the dextrose concentration is multiplied times thepatient's weight in kilograms to determine the dextrose flow rate inmL/hour. This will result in a dextrose flow rate in grams per kilogramper hour that is independent of the user specified dextroseconcentration. In it's current format, the glucose control algorithmassumes that the insulin concentration used will be 1 internationalunit/mL. If an alternative insulin concentration is used, the INSfn, asdetermined by the algorithm, will need to be multiplied by the inverseof the insulin concentration. As an example, if an insulin concentrationof 0.5 international units/mL is used, then INSfn will by multiplied by(1/0.5=2) to come up with the appropriate flow rate of INSfn in mL/hour.

Stated differently, the computerized glucose adjustment system of FIG. 4implements software to (i) determine where the patient's real-timeaverage blood glucose level (“Xa”) lies along a continuum of glucosevalues; (ii) track the rate at which the average blood glucose level ischanging over time; (iii) determine the status of the previous weightbased insulin flow rate; and (iv) determine the status of the previousweight-based dextrose flow rate. By determining these four parameters,the system of this invention utilizes pre-programmed insulin flow rateadjustment factors and dextrose flow rate adjustment factors to changethe flow rates for the next time period. The system continuously updatesthis process with new measurements from the glucose sensor (24) and anychanges input manually by a medical professional.

The computer processor's glucose control module groups the followingvalues in determining the insulin and dextrose adjustment factors: (i)difference between the most recently calculated average blood glucosevalue and the desired glucose range; (ii) the rate at which the averageblood glucose value is changing over a specified time period; (iii) thevalue of the weight-based insulin flow rate; and (iv) the value of theweight-based dextrose flow rate. By grouping these parameters each timea new average glucose level Xa is calculated, the system better selectsthe appropriate insulin and dextrose flow rate adjustment factors. Insome cases, the insulin and dextrose flow rates will be changed fromzero to a positive value greater than zero. At other times, the insulinand dextrose flow rates will be changed from a positive value to zero.

In one embodiment, the dextrose adjustment factor is selected from thegroup consisting of 0, 0.7, 0.75, 0.8, 0.85, 0.9, 0.95, 1.0, 1.05, 1.1,1.2, 1.25, 1.3, 1.4, 1.5, and 1.7. Additionally, the insulin adjustmentfactor may be selected from the group consisting of 0, 0.5, 0.75, 0.80,0.85, 0.9, 0.95, 1.0, 1.05, 1.1, 1.15, 1.2, 1.3, 1.4, 1.5, 1.6, and 1.7.In order to improve its speed at arriving at the user specified normalglucose range, the system may be programmed with a step of administeringbolus doses of insulin for all glucose values greater than or equal toXmax+20 mg/dL, and when the rules of either 218, 219, or 220 are met.These bolus doses may not be administered more often than every 30minutes. As mentioned above, the medical personnel may manually set thevalues of an initial insulin flow rate and an initial dextrose flow rateprior to the step of continuously measuring the patient's real timeglucose level.

In other embodiments, the dextrose flow rate and the insulin flow rateare adjusted by an amount determined according to the patient's weight.As noted above, the dextrose formulation typically has a concentration(C) selected from the group consisting of 5, 10, 12.5, 15, 20, and 25 inpercent weight per volume. The dextrose flow rate may be adjusted in acomputer controlled process that determines the next flow rate as amultiple of 1/C multiplied by the patient's weight. In some instances,the above numerator 1 may be changed to 2, 3 or 6. In weight basedinsulin flow management, a known weight multiplier (e.g. 0.01, 0.02,0.03) may be multiplied by the patient's weight to determine the nextinsulin flow rate when the previous insulin flow rate was zero.

As noted in the attached Table, when the closed loop system detectsglucose levels above a certain maximum, the insulin flow rate wouldinclude a calculated flow rate according to the algorithm plus a bolusdose to rapidly adjust the glucose level to a normal range.

The algorithm for setting the next insulin infusion rate (INSfn)includes an additional checking protocol to account for criticalsituations in which the glucose values are outside the desired range andvarying widely. The checking protocol for these situations is referredto herein as the Secondary Controller. The Algorithm for the SecondaryController is set forth in more detail below. Without limiting theinvention to any one set of instructions, the Secondary controller mayinclude instructions for fine tuning the next insulin flow rate (INSfn)to an adjusted value (INSfn2c) output from the Secondary Controller(referred to as “2C”).

The Secondary Controller accounts for situations in which the currentlyaveraged glucose value Xa is less than the minimum desired value (Xmin).In addition, the secondary controller is designed to handle outliersituations whereby the glucose is rising or falling at an excessiverate, such that the primary controller may not be able to keep up withthe rate of change. The secondary controller can change the cycleinterval of the glucose controller from its standard interval of tenminutes to five minutes, and back to ten minutes as needed. Thisprovides additional feedback to the system for adjusting the glucosevalue more rapidly when the glucose is too low, or rising/falling toorapidly.

The Secondary Controller is actually a series of secondary controllersthat are executed one after another until all 27 rules have beenassessed for relevancy to the current situation at hand. The order andfunction of the series of secondary controllers is as follows:

-   -   a) Rules 1-8: These rules modify INSfn when Xa is <Xmax and the        rate of glucose change (Xa−Xb) is excessive given the current        glucose level=Xa.    -   b) Rule 9: This rule serves to initiate a dextrose infusion when        the current glucose level Xa is <100 mg/dL and the rate of fall        of glucose is <−12 mg/dL per 10 minute period=a rate of fall        <−1.2 mg/dL/min and the primary glucose controller rule for        Dexfn is 0.    -   c) Rules 10-11: These rules modify Dexfn when the rate of fall        or rise of glucose is excessive and the rule for Dexfn is >0        mL/hour.    -   d) Rules 12-19: These rules modify INSfn when the current        glucose value Xa is ≧Xmax and the rate of rise or fall of        glucose is excessive.    -   e) Rules 20-27: These rules switch the cycle interval between        the standard interval of 10 minutes and a more frequent cycle of        5 minutes based on the current glucose level (Xa) and the rate        of rise or fall of glucose.

Thus, the cycle interval is not fixed; rather, it fluctuates based onthe values of Xa and (Xa−Xb). If the cycle interval is changed to 5minutes, the subsequent values of (Xa−Xb) must be multiplied by 2 beforethe (Xa−Xb) value is run through the primary and secondary glucosecontrol algorithms, as the algorithms were built on a standard cycleinterval of 10 minutes. There will be no modification of (Xa−Xb) if thecycle interval is 10 minutes. Details of the Secondary Controller areset forth at Paragraph 113 following the Osmolality Algorithm Tablebelow.

The pump (40) receives the updated insulin/dextrose data from theglucose control module (36) and adjusts output accordingly.

The glucose adjustment system disclosed herein exceeds the accuracy ofpreviously known protocols used in numerous medical settings. FIG. 7shows a plot comparing (i) the glucose levels that would be attainedusing the currently described automated protocol (denoted “MIMO” formultiple input multiple output) with 10 minute cycling intervals and(ii) paper protocols previously used to adjust glucose levels with nurseor physician supervision (i.e., Yale¹⁶, Thomas Jefferson¹⁷, andAmarillo¹⁸ paper protocols). The results of the paper protocols arecompared to those of the new MIMO system utilizing a new simplified ICUglucose-insulin model to estimate results that the paper protocols wouldmost likely achieve. FIG. 7 indicates that the automated protocoldescribed herein achieves a tighter glucose control more quickly thanthe paper protocols.

FIG. 8 shows the corresponding insulin flow rates for each protocol ofFIG. 7. FIG. 8 further illustrates that, in addition to utilizing acontinuous infusion of intravenous insulin to lower elevated glucoselevels, the automated model also uses a continuous infusion of dextrosein states of hypoglycemia to account for glycogenolysis/gluconeogenesis.

Overall, FIGS. 7 and 8 illustrate a simplified patient model to test theresults of the new controller against known paper based insulinprotocols. The concept of the Insulin Dose To Achieve Static GlucoseLevel (IDTASGL) is shown in FIG. 8. This is the exogenous insulin doseat which the glucose elevating effects of stress hormones, intravenousdextrose, enteral feeds, steroids, etc are balanced by the glucoselowering properties of the exogenous insulin, and the blood glucose,regardless of its level, will remain static. Rules are provided in thesimplified ICU glucose-insulin model to account for the rate of rise ofblood glucose when the exogenous insulin dose is less than the IDTASGL,and the rate of fall when the exogenous insulin dose exceeds theIDTASGL. In the examples of FIGS. 7 and 8, the controller adjusts itsinsulin dose every ten minutes. The insulin protocols used forcomparison are cycled as frequently as allowed by the protocol.

FIG. 9 illustrates the results when the MIMO protocol is also comparedto itself using different cycle intervals. The shorter cycling intervalsproduce tighter glucose control. For ease of calculation, each newinsulin dose is judged to have effect only during the period of thatdoses infusion. The IDTASGL changes throughout the test period tosimulate that which occurs in real life. In the comparison of differentcycle interval scenario, the insulin effects were increased by 300% atthe 26^(th) hour or 156^(th) time interval mark.

FIG. 10 shows the insulin flow rates corresponding to the glucosemanagement of FIG. 9 using the MIMO protocol described herein.

Osmolality Embodiment

In a different embodiment of the system, the computerized methodaccomplishes blood osmolality management via a blood osmolalityadjustment system. As noted above, the system includes a catheter (10)placed within the patient's vascular system for direct contact with thebloodstream. The catheter (10) includes a conductivity sensor (20)attached to the catheter. The conductivity sensor (20) may be formed ofvarious configurations that are commonly used in the art of biomedicalengineering. In general, however, one particularly useful embodiment ofthe conductivity sensor (20) includes four electrodes (20A, 20B, 20C,and 20D) in direct contact with the bloodstream. A current driven acrossone pair of the electrodes (20A, 20D) passes through the bloodstream andinduces a voltage across two other sensing electrodes (20B, 20C). Thevoltage signal transmits back to a computer processor (37) whichconverts the signal to an osmolality measurement by the followingformula:

Serum osmolality (mOsm)=18.95 mOsm/mSiemen×Measured conductivity(mSiemen))

In line with the glucose embodiment detailed above, the system of thisinvention includes the ability to regulate blood osmolality with a fluidinfusion from an electronically controlled pump (40). In one embodiment,the pump (40) is connected to a source of saline (47) and adjusts theamount of saline infused into the patient's bloodstream in response toblood conductivity measurements from the conductivity sensor (20). In apreferred embodiment, the saline is hypertonic saline.

A computer processor (37) calculates the osmolality level as a functionof the blood conductivity measured from the voltage signal transmittedfrom the conductivity sensor (20) attached to the catheter (10). Thecomputer processor (37) is in electronic communication with both thesensor (20) and the fluid pump (40) to use the bloodconductivity/osmolality measurement to control pump output. Uponreceiving the osmolality calculations from the blood conductivitymeasurements, the computer processor (37) calculates the patient'sreal-time average osmolality level over the specified time period.

A fluid infusion control module stored in the computer processor (37)utilizes input osmolality measurements to create output signals. Thefluid infusion control module sends the output signals to the pump forcontrolling the rate at which the pump distributes saline into thepatient. The fluid infusion control module includes pump controllingcommands programmed therein. These commands implement software to (i)determine where the patient's real-time average blood osmolality level(“Ya”) lies along a continuum of osmolality values; (ii) track the rateat which the average blood osmolality measurement is changing over time;and (iii) iteratively adjust the saline fluid flow rate into thepatient's body to adjust the average osmolality level closer to a knownnormal osmolality range.

Although infusing saline into patients has been known for decades fortreating numerous conditions, utilizing controlled saline flow rates,particularly those calculated as a function of the patient's weight inkilograms, offers added functionality to a closed loop osmolalitymanagement system.

Implementing the controlled osmolality adjustment system herein maybegin by programming the processor (37) to accept as an input theinitial concentration of the saline being infused into the patient. Forconvenience, this initial concentration of hypertonic saline is referredto as “Z”.

The computerized osmolality adjustment system, which operatescontinuously on a real time basis, iteratively receives osmolalitycalculations derived from the conductivity sensor (20) measurementstransmitted from the catheter (10), analyzes those calculations,calculates the average osmolality level over a specified time period,and sends an output signal to the pump (40) managing fluid infusion. Thefluid is typically hypertonic saline, but other medically suitableformulations would also fall within the scope of this system.

To ensure that the osmolality adjustment system described hereinperforms in optimal fashion, the system is capable of allowing a user toset a user specified normal osmolality range between OsmSl and OsmSh.The minimum osmolality value, OsmSl, is also referred to as the lowosmolality set point (OsmSl). The maximum osmolality set point is knownas the high osmolality set point (OsmSh). This range between OsmSl andOsmSh becomes the target that the computerized osmolality adjustmentsystem seeks to achieve in real-time blood osmolality calculations.

As a first step toward achieving blood osmolality levels within theselected range, the fluid infusion control module calculates and storesin appropriate mathematical units (typically milliosmoles/Kg) an averageblood osmolality level Ya for a specified time period. For example, theOsmolality control module may calculate and store a “current” bloodOsmolality value Yt (i.e., blood osmolality calculation at time t) every30 seconds and calculate the average osmolality level Ya over aspecified time period equal to 10 minutes, or whatever time period isspecified by the user. In other words, the osmolality adjustment systemkeeps a running average of the average blood osmolality level asmeasured by the catheter's conductivity sensor in the patient'sbloodstream. At any given time, the controller has available to it theaverage blood osmolality level for the previous 10 minutes, or whatevertime period has been selected by the user.

The control loop operates via pump controlling commands that determinethe flow rate of fluid, such as hypertonic saline, into the patient. Thepump controlling commands are divided into categories defined byosmolality control ranges along the continuum of osmolality values. Theosmolality adjustment system defined herein involves the control modulecalculating which of the pump controlling command categories isappropriate for a particular average blood osmolality value Ya. In otherwords, as the conductivity sensor (20) on the catheter (10) transmitsblood conductivity data back to the computer processor, the processorelectronically calculates the average blood osmolality value, andassigns the average osmolality value (Ya) to a category of pumpcontrolling commands.

The pump controlling command categories are further divided into groupsdetermined by finite formulas based on OsmSl and OsmSh. In one suchformula, the pump controlling command categories are defined by theamount that the currently averaged blood osmolality value that has justbeen calculated (Ya) differs from the minimum acceptable value for bloodosmolality for this patient (OsmSl). Other categories are based on thedifference between Ya and OsmSh.

The next step in the algorithm implemented by the computerized system ofthis invention is for the control module to compare the current averageosmolality measurement Ya to the prior average osmolality measurementYb. This calculation determines the rate at which the average bloodosmolality level is changing between measurements. In one embodiment ofthis invention, the time between osmolality measurements can be set bythe user.

The system intelligently groups real-time human physiological parametersand determines the appropriate command or electronic signal that directsthe pump output (i.e., the amount of hypertonic saline infused into thepatient.) The osmolality adjustment system utilizes the fluid infusioncontrol module to direct pump controlling commands for adjusting pumpoutput. The pump controlling commands direct the pump to control theflow rates of hypertonic saline according to the category in which themost recent average osmolality calculation fits and the rate at whichthe osmolality level is changing.

For example, the pump controlling commands depend, at least in part,upon the following conditions: (i) the amount the average bloodosmolality level (Ya) differs from a known or desirable normal rangebetween OsmSl and OsmSh, (ii) the amount the average blood osmolalitylevel (Ya) has changed from a previously calculated value (Yb), and(iii) the known weight based flow rate of hypertonic saline (HTSfp)effective at the time the average osmolality calculation was calculated.Using these factors, the algorithm implemented herein determines how thehypertonic saline flow rate from the pump (40) should be adjusted tooptimize the real-time blood osmolality value (Yt) for the patient atissue.

Stated differently, the algorithm of this invention utilizes a bloodosmolality value calculated from blood conductivity data transmittedfrom a blood conductivity sensor (20) on an intravenous catheter (10) tothe computerized osmolality adjustment system. In one embodiment, thecomputer processor (37) is programmed to receive sensor measurements ata specified time interval such as every 30 seconds. The processor (37)calculates blood osmolality from the conductivity measurements.

Once the average blood osmolality level Ya has been calculated for aselected time period and the appropriate pump controlling command setdetermined, the computer processor (37) turns to the steps involved indirecting pump output. As part of the blood osmolality control module,the rate of fluid infusion, typically hypertonic saline infusion, ismaintained in electronic format for use by the controller. A medicalprofessional sets initial values for fluid flow rate. In the computerprocessor, this value would be the first value used for “previous” flowrate (HTSfp) in the calculations at hand. For example, in oneembodiment, the previous (or current) flow rate for hypertonic saline isreferred to herein as HTSfp. Over each osmolality measurement iteration,the processor uses the average blood osmolality value Ya, the just prioraverage blood Osmolality value Yb, and the most recent pump state forhypertonic saline flow rate (HTSfp) to determine how to calculate anupdated pump command for the next hypertonic saline flow rate (HTSfn).

In one embodiment of this invention, the pump controlling commands setthe hypertonic saline flow rate into the patient as a function of thepatient's weight in kilograms (Wt). The pump controlling commands use amultiplier divided by the initial hypertonic saline concentration (Z)value set by the medical professional multiplied by the patient's weightin kilograms (Wt). The hypertonic flow rate calculations determine whichof several flow rate adjustment factors can be used and converted topump controlling command output signals. As noted above, the pumpcontrolling commands direct the pump to change the infusion flow ratefor the fluid, such as hypertonic saline, that adjusts blood osmolality.

To further assist the medical professional in monitoring a patient, thesystem includes software for setting low and high alarm set points forosmolality values, hypertonic saline flow, and for differentials betweenvarious blood osmolality measurements. The system also encompasses amethod of calibrating the osmolality algorithm. In a preferredembodiment, the system will be calibrated at least every twelve hours.The blood for this calibration will be obtained from an arterial/venousdraw, or from an indwelling arterial/venous line after the dead space ofthe line has been sufficiently cleared.

Another way of describing the osmolality adjustment embodiment of thisinvention is in terms of the computerized method of using hypertonicsaline flow rate adjustment factors to optimize blood osmolality levels.As set forth herein, a computerized method of adjusting a patient'sblood chemistry on a real time basis includes adjusting the patient'saverage blood osmolality level toward a known user specified normalrange by multiplying a currently known hypertonic saline flow rate byadjustment factors. The adjusted flow rates control the amount of salinepumped into a patient's bloodstream. The method of this invention beginsby continuously measuring the patient's real time blood conductivity andcalculating blood osmolality from that measurement. Next, the systemstores each real time blood osmolality level in a computer processor,and calculates via the computer processor an average osmolality level,Ya, over a specified time period.

The method further includes electronically assigning the averageosmolality level to one of a series of osmolality control ranges. Bycalculating the rate at which the average osmolality level changes fromone of the specified time periods to the next, and also taking intoconsideration the current weight based hypertonic saline flow rate(HTSfp) the method determines the fluid flow rate adjustment factornecessary to achieve an average osmolality level as specified by thebedside clinician.

The flow rate adjustment factor depends upon the state of the previousflow rate already in effect for the patient at hand. The adjustmentfactors are not static numbers that remain the same for every patient,but rather, the adjustment factors generally depend upon the previousweight based flow rate, the difference of the blood Osmolalitymeasurement from a user defined range of blood Osmolality and the rateof change of the blood Osmolality over time.

Stated differently, the computerized blood osmolality adjustment systemof FIG. 4 implements software to (i) determine where the patient'sreal-time average blood osmolality level (“Ya”) lies along a continuumof blood osmolality values; (ii) track the rate at which the averageblood osmolality level is changing over time; and (iii) determine thestatus of the currently effective, or previous, weight based hypertonicsaline flow rate. By determining these parameters, the system of thisinvention utilizes pre-programmed fluid flow rate adjustment factors tochange the flow rates for the next time period. The system continuouslyupdates this process with new measurements from the catheter and anychanges input manually by a medical professional.

The computer processor's fluid infusion control module groups thefollowing values in determining the hypertonic saline's adjustmentfactors: (i) difference between the most recently calculated averageblood osmolality value and the desired osmolality range; (ii) the rateat which the average blood osmolality value is changing over a specifiedtime period; and (iii) the value of the weight based hypertonic salineflow rate. By grouping these parameters each time a new average bloodosmolality level Ya is calculated, the system better selects theappropriate fluid flow rate adjustment factors.

In one embodiment, the saline adjustment factor is selected from thegroup consisting of 0, 0.5, 0.6, 0.7, 0.8, 0.85, 0.86, 0.87, 0.9, 0.92,0.94, 0.95, 0.96, 0.97, 0.98, 0.99, 1.0, 1.01, 1.02, 1.03, 1.04, 1.05,1.06, 1.07, 1.1, 1.15, 1.2, 1.24, 1.25, 1.3, 1.4 and some other valuecalculated as a function of the initial fluid concentration (Z) and thepatient's weight. As mentioned above, the medical personnel may manuallyset the values of an initial saline flow rate prior to the step ofcontinuously measuring the patient's real time blood osmolality.

Similar to the dextrose flow adjustment described above, the hypertonicsaline flow is also a weight based value. In clinical practice, thenurse selects the hypertonic saline concentration on start up (e.g., 3%,7.5%, etc.). In calculating the initial hypertonic saline infusion rate,the hypertonic concentration number (e.g. 3, 7.5) is considered avariable Z in the computerized system. In other words, the concentrationnumber is the percent concentration value expressed as a real number.The computerized system tracks the hypertonic saline flow rate accordingto ranges based on a multiple of the inverse hypertonic salineconcentration number and the patient's weight adjusted by a multiplier.For example, the hypertonic saline flow rate might be expressed invalues similar to the following expression:

0.6*Wt*3/Z<HTSfp≦1*Wt*3/Z.

In the above expression, Wt=the patient's weight in kilograms, Z=thehypertonic saline concentration number, 0.6 is the weight multiplier,and 3 is the multiplier for the inverse hypertonic saline concentrationnumber. Depending upon the osmolality trends in the patient'sbloodstream and the previous hypertonic saline flow rate HTSfp, the nexthypertonic saline flow rate, HTSfn, is adjusted by either a straightmultiplier or if HTSfp was zero, it is begun at an amount determined bythe patient's weight and a multiplier (i.e., 0.15*Wt*3/Z).

Those having skill in the art will recognize that the invention may beembodied in many different types of computerized algorithms.Accordingly, the invention is not limited to the particular structuresor software illustrated herein.

In the drawings and specification there has been set forth a preferredembodiment of the invention, and although specific terms have beenemployed, they are used in a generic and descriptive sense only and notfor purposes of limitation, the scope of the invention being defined inthe claims.

ENDNOTES FOR ABOVE REFERENCED CITATIONS

-   1. Qiu W, Journal of Critical Care 2007; September 22(3): 229-235.-   2. Circulation 2005; December 112 (Issue 24 Suppl): IV Part 7.5.-   3. Jeremitsky E, Journal of Trauma 2003; 54(2): 312-319.-   4. Gentile N, Academy of Emergency Medicine 2006; 13(2): 174-180.-   5. Mullner M, Journal of Cerebral Blood Flow & Metabolism 1997; 17:    430-436.-   6. Van Den Berghe G, New England Journal of Medicine 2001; 345:    1359-1367.-   7. Krinsley J, Mayo Clinic Proceedings 2004; 79(8):992-1000.-   8. Van Den Berghe G, New England Journal of Medicine 2006; 354:    449-461.-   9. Furnary A, Endocrine Practice 2004; 10(Suppl 2): 21-31.-   10. Brunkhorst F, New England Journal of Medicine 2008; 358:125-139.-   11. Bhardwaj A, Current Opinion in Critical Care 2004; 10(2):    126-131.-   12. Zadeh L, Information and Control 1965; 8: 338-353.-   13. Van Den Berghe G, Critical Care Medicine 2006; 34(3): 612-616.-   14. Verbrugge L, Anesthesiclogy 2007; 107: A1427.-   15. Zisser H, Accuracy of a novel intravascular fluorescent    continuous glucose sensor. American Diabetes Association Meeting,    Jun. 5-9, 2009, New Orleans, La. Abstract 1-LB.-   16. Goldberg P., Siegel M., et al. Implementation of a safe and    effective insulin infusion protocol in a medical intensive care    unit; Diabetes Care 2004; 27:461-467.-   17. Beilman G., Joseph J., Practical Considerations for Glucose    Control in Hospitalized Patients; Diabetes Technology & Therapeutics    2005; 7:823-830.-   18. www.amarillomed.com/diabetes/hospform.htm

Glucose Algorithm Definitions/Characteristics

-   1. Xt=Glucose value measured at time t with time measured in    seconds.-   2. Xa=Average glucose value measured over previous 10 minutes.-   3.    Xa=(X0+X30+X60+X90+X120+X150+X180+X210+X240+X270+X300+X330+X360+X390+X420+X450+X480+X510+X540+X570)/20,    wherein these are glucose values measured every 30 seconds over the    previous 10 minute period.-   4. For all values of Xt whereby Xt<Xa−2 standard deviations or    Xt>Xa+2 standard deviations, then Xt is not included in calculation    of Xa.-   5. Xb=Average glucose value measured over 10 minute period    immediately prior to Xa-   5a. Xc=Average glucose value measured over 10 minute period    immediately prior to Xb.-   6. Xmin=Set point for “Low end of glucose range”-   7. Xmax=Set point for “High end of glucose range”-   8. INSSh=Set point for “Maximum insulin Infusion Rate”-   9. INSf=Insulin flow rate in Units/hour-   10. INSfp=Insulin flow rate in Units/hour over previous 10 minutes-   11. INSfn=Insulin flow rate in Units/hour over next 10 minutes-   12. Dexf=Dextrose flow rate in mL/hour-   13. Dexfp=Dextrose flow rate in mL/hour over previous 10 minutes-   14. Dexfn=Dextrose flow rate in mL/hour over next 10 minutes-   15. Wt=Patient's weight in Kilograms-   16. 18 mg/dl glucose=1 mmol/L glucose-   17. On start up initial insulin flow (INSf) set by    nurse/physician=INSfp-   18. On start up initial dextrose flow (Dexf) set by    nurse/physician=Dexfp-   19. Algorithm begins on start up after two average (Xa & Xb) glucose    values obtained; however nurse may set INSf and Dexf which will be    used as “INSfp” and “Dexfp” for the first cycle through the    algorithm-   20. Glucose average values calculated and algorithm adjusts Dexfn &    INSfn every 10 minutes (12:00, 12:10, 12:20, etc)-   21. Temp=intravascular temperature measured by thermistor-   22. Nurse selects Dextrose concentration (weight/volume) on start up    and in calculating initial glucose infusion rate entered Dextrose    concentration number (5, 10, 12.5, 15, 20, 25) is considered    variable “C”.-   23. If Xmin<80 mg/dL glucose then Xmin=80 mg/dL glucose-   24. DexSh=Maximum dextrose rate in mL/hour set by nurse/physician-   25. MIVFR=Maintenance intravenous fluid rate calculated by algorithm-   26. TIVFR=Total intravenous fluid rate set by nurse/physician-   27. Glucose algorithm assumes three separate infusions will be used    which will consist of: 1) High dextrose solution with electrolyte    composition to match that of maintenance intravenous fluid, 2)    Insulin infusion with concentration of insulin infusion in “IU/mL”    to be entered by nurse on start up, 3) Maintenance intravenous fluid-   28. Glucose value as measured by glucose sensor on neurocatheter    will be calibrated against blood glucose obtained from patient at    least every 6 hours-   29. Conc=concentration of insulin infusion in International Units    (IU)/mL-   30. When Xa<Xmin, the algorithm will measure glucose values every    five minutes as follows:    Xa=X0+X30+X60+X90+X120+X150+X180+X210+X240+X270/10. The resulting    value for Xa will be run through the algorithm as with all values of    Xa≧Xmin, utilizing the immediately prior glucose value as Xb. This    process will continue until Xa≧Xmin at which point the algorithm    will return to ten minute intervals of calculation/adjustment,    unless otherwise directed by the secondary controller.-   31. When the rules of either 218, 219 or 220 are met, a bolus dose    of insulin will be infused over the subsequent 10 minutes and will    be given concurrently with INSfn as calculated by the algorithm. The    bolus doses of insulin may not be given more frequently than every    30 minutes. While bolus dose of insulin is infusing monitor will    display “Bolus Dose of Insulin Infusing”-   32. Intravenous pump will display rates of high dextrose solution,    insulin infusion and maintenance intravenous solution in mL/hour.    Below this display there will be an additional display that will    scroll horizontally every 10 seconds the following: 1) for the high    dextrose solution grams dextrose/hour will be displayed (ex.    “dextrose 2 grams/hour”); 2) for the insulin infusion the insulin    dose in units/Kg/hour will be displayed (“insulin 0.1    units/Kg/hour”)-   33. If (Xmax−Xmin)<30 mg/dL then Xmax=Xmin+30 mg/dL

Glucose Alarm Events

-   1. “Low Glucose” alarm sounded when measured glucose is less than    “Lower Glucose Alarm Limit” which may be the same or less than Xmin.    This lower glucose alarm limit is set by the nurse/physician.-   2. “High Glucose” alarm sounded when measured glucose is greater    than “Upper Glucose Alarm Limit” which may be the same or greater    than Xmax. This upper glucose alarm limit is set by the    nurse/physician.-   3. “Check Capillary Blood Glucose” alarm sounded whenever the “Low    Glucose” or “High Glucose” alarms are sounded. In addition, if    Xa−Xb<−25 mg/dL glucose or >25 mg/dL glucose activate alarm “Check    Capillary Blood Glucose” & display “Time vs Glucose Value” graph-   4. “Check Catheter Position” alarm sounded if Xa<40 mg/dL glucose or    Temperature <32 degrees Celsius/89.6 degrees Fahrenheit.-   5. “Maximum Insulin Infusion Rate” alarm sounded if INSfn≧INSSh.-   6. If INSfn=0 units/hour and Dexfn>0 mL/hour then display “Insulin    Infusion Off” & “Dextrose Infusing”-   7. “Maximum Dextrose Infusion Rate” alarm sounded if (Dexfn≧DexSh).-   1. If (Xa−Xmin<−10 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0    units/hour) then Dexfn=(6/X*Wt) mL/hour and INSfn P (INSfp*0.5)-   2. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb<−3 mg/dL) and (Dexfp>0 mL/hour)    and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.05*Wt) units/hour) then Dexfn=(Dexfp*1.7) and INSfn=0    units/hour-   3. If (Xa−Xmin<−10 mg/dL) and (Xa Xb<−3 mg/dL) and (Dexfp>0 mL/hour)    and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>(0.05*Wt) units/hour) then    Dexfn=(Dexfp*1.7) and INSfn=(INSfp*0.85)-   4. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb<−3 mg/dL) and (Dexfp>(2/X*Wt)    mL/hour) and (Dex≦(6/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp<(0.05*Wt) units/hour) then Dexfn=(Dexfp*1.2) and INSfn=0    units/hour-   5. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb<−3 mg/dL) and (Dexfp>(2/X*Wt)    mL/hour) and (Dex≦(6/X*Wt) mL/hour) and (INSfp≧(0.05*Wt) units/hour)    then Dexfn=(Dexfp*1.2) and INSfn=(INSfp*0.85)-   6. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb<−3 mg/dL) and (Dexfp>(6/X*Wt)    mL/hour) and (INSfp>0 units/hour) and (INSfp<(0.05*Wt) units/hour)    then Dexfn=(Dexfp*1.1) and INSfn=0 units/hour-   7. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb<−3 mg/dL) and (Dexfp>(6/X*Wt)    mL/hour) and (INSfp>(0.05*Wt) units/hour) then Dexfn=(Dexfp*1.1) and    INSfn=(INSfp*0.85)-   8. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>0 mL/hour)    and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=(Dexfp*1.3) and INSfn=0    units/hour-   9. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>0 mL/hour)    and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>(0.02*Wt) units/hour) then    Dexfn=(Dexfp*1.3) and INSfn=(INSfp*0.85)-   10. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>(2/X*Wt)    mL/hour) and (Dextp≦(6/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=(Dexfp*1.2) and INSfn=0    units/hour-   11. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>(2/X*Wt)    mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and (INSfp>(0.02*Wt)    units/hour) then Dexfn=(Dexfp*1.2) and INSfn=(INSfp*0.85)-   12. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>(6/X*Wt)    mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.02*Wt) units/hour)    then Dexfn=(Dexfp*1.1) and INSfn=0 units/hour-   13. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>(6/X*Wt)    mL/hour) and (INSfp>(0.02*Wt) units/hour) then Dexfn=(Dexfp*1.1) and    INSfn=(INSfp*0.75)-   14. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb<−3 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.7) and INSfn=INSfp-   15. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb<−3 mg/dL) and (Dexfp>(2/X*Wt)    mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.4) and INSfn=INSfp-   16. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp>(6/X*Wt)    mL/hour) and (INSfp=0 units/hour) then Dexfn=(Dexfp*1.2) and    INSfn=INSfp-   17. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.5) and INSfn=INSfp-   18. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>(2/X*Wt)    mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.3) and INSfn=INSfp-   19. If (Xa−Xmin<−10 mg/dL) and (Xa−Xb≧−3 mg/dL) and (Dexfp>(6/X*Wt)    mL/hour) and (INSfp=0 units/hour) then Dexfn=(Dexfp*1.2) and    INSfn=INSfp-   20. If (Xa−Xmin<−10 mg/dL) and (Dexfp=0 mL/hour) and (INSfp==0    units/hour) then Dexfn=(6/x*Wt) mL/hour and INSfn=INSfp-   21. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=(3/X*Wt) mL/hour and INSfn=0    units/hour-   22. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=(3/X*Wt) mL/hour and    INSfn=(INSfp*0.85)-   23. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=(3/X*Wt) mL/hour and INSfn=(INSfp*0.9)-   24. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=Dexfp and INSfn=0 units/hour-   25. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.9)-   26. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp≧(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*0.85)-   27. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour) then    Dexfn=(Dexfp*1.5) and INSfn=0 units/hour-   28. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=(Dexfp*1.5) and INSfn=(INSfp*0.8)-   29. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.5) and    INSfn=(INSfp*0.9)-   30. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and    (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour) then    Dexfn=(Dexfp*1.3) and INSfn=0 units/hour-   31. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt units/hour) then    Dexfn=(Dexfp*1.3) and INSfn=(INSfp*0.8)-   32. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.3) and    INSfn=(INSfp*0.9)-   33. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*1.2) and INSfn=0    units/hour-   34. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.01*Wt) units/hour)    and (INSfp≦(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.1) and    INSfn=(INSfp*0.8)-   35. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.1*Wt) units/hour)    then Dexfn=(Dexfp*1.1) and INSfn=(INSfp*0.9)-   36. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧−3    mg/dL) and (Xa−Xb<1 mg/dL) and (Dexfp>0 mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*1.1)    and INSfn=0 units/hour-   37. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧−3    mg/dL) and (Xa−Xb<1 mg/dL) and (Dexfp>0 mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=(Dexfp*1.1) and INSfn=(INSfp*0.85)-   38. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧−3    mg/dL) and (Xa−Xb≦1 mg/dL) and (Dexfp>0 mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=(Dexfp*1.1) and INSfn n (INSfp*0.95)-   39. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧1    mg/dL) and (Dexfp>0 mL/hour) and (INSfp>0 units/hour) then    Dexfn=(Dexfp*1.1) and INSfn=(INSfp*0.95)-   40. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−1    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp=0 units/hour) then Dexfn=(Dexfp*1.5) and INSfn=0 units/hour-   41. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−1    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦6/X*Wt) mL/hour) and    (INSfp=0 units/hour) then Dexfn=(Dexfp*1.3) mL/hour and INSfn=0    units/hour-   42. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−1    mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.1) mL/hour and INSfn=0 units/hour-   43. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧−1    mg/dL) and (Dexfp>0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.1) mL/hour and INSfn=0 units/hour-   44. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb<−1    mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=(3/X*Wt) mL/hour and INSfn=INSfp-   45. If (Xa−Xmin≧−10 mg/dL) and (Xa−Xmin<−5 mg/dL) and (Xa−Xb≧−1    mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=(2/X*Wt) mL/hour and INSfn=INSfp-   46. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt)    units/hour) then Dexfn=(2/X*Wt) mL/hour and INSfn=0 units/hour-   47. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=(2/X*Wt) mL/hour and    INSfn=(INSfp*0.8)-   48. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=(2/X*Wt) mL/hour and INSfn=(INSfp*0.9)-   49. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb≧−2 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt)    units/hour) then Dexfn=Dexfp and INSfn=0 units/hour-   50. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb≧−2 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn. Dexfp and INSfn=(INSfp*0.85)-   51. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb≧−2 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*0.95)-   52. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*1.5)    and INSfn=0 units/hour-   53. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>0 ml/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=(Dexfp*1.5) and INSfn=(INSfp*0.85)-   54. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.5) and    INSfn=(INSfp*0.9)-   55. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦6/X*Wt) mL/hour) and    (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour) then    Dexfn=(Dexfp*1.25) mL/hour and INSfn=0 units/hour-   56. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦6/X*Wt) mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=(Dexfp*1.25) mL/hour and INSfn=(INSfp*0.85)-   57. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dextp>(2/X*Wt) mL/hour) and (Dexfp≦6/X*Wt) mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.25) mL/hour and    INSfn=(INSp*0.9)-   58. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*1.1) mL/hour and    INSfn=0 units/hour-   59. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.1) mL/hour and INSfn    (INSfp*0.85)-   60. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−2 mg/dL)    and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=(Dexfp*1.1) mL/hour and INSfn=(INSfp*0.9)-   61. If (Xa−Xmin≧−5 mg/di) and (Xa<Xmin mg/dL) and (Xa−Xb≧−2 mg/dL)    and (Dexfp>0 mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt)    units/hour) then Dexfn=Dexfp and INSfn=0 units/hour-   62. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb≧−2 mg/dL)    and (Dexfp>0 mL/hour) and (INSfp>(0.01*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*0.95)-   63. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−1 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp=0    units/hour) then Dexfn=(Dexfp*1.5) and INSfn=INSfp-   64. If (Xa−Xmin≧−5 mg/dl) and (Xa<Xmin mg/dL) and (Xa−Xb<−1 mg/dL)    and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and    (INSfp=0 units/hour) then Dexfn=(Dexfp*1.25) and INSfn=INSfp-   65. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−1 mg/dL)    and (Dexfp>(6/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.1) and INSfn=INSfp-   66. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb≧−1 mg/dL)    and (Dexfp>0 mL/hour) and (INSfp=0 units/hour) then Dexfn=Dexfp and    INSfn=INSfp-   67. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb<−1 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then Dexfn=(2/X*Wt)    mL/hour and INSfn=INSfp-   68. If (Xa−Xmin≧−5 mg/dL) and (Xa<Xmin mg/dL) and (Xa−Xb≧−1 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then Dexfn=Dexfp and    INSfn=INSfp-   69. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb<−2 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=Dexfp and INSfn=0 units/hour-   70. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.01*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*0.85)-   71. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.9)-   72. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧−2 mg/dL) and (Xa−Xb≦3 mg/dL) and (Dexfp=0 mL/hour) and    (INSfp>0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   73. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧3 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*1.05)-   74. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb<−2 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour)    and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour) then    Dexfn=(Dexfp*1.5) and INSfn=0 units/hour-   75. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour)    and (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour)    then Dexfn=(Dexfp*1.5) and INSfn=(INSfp*0.85)-   76. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour)    and (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.5) and    INSfn=(INSfp*0.9)-   77. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt)    mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour)    then Dexfn=(Dexfp*1.25) and INSfn=0 units/hour-   78. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt)    mL/hour) and (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt)    units/hour) then Dexfn=(Dexfp*1.25) and INSfn=(INSfp*0.85)-   79. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt)    mL/hour) and (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.25) and    INSfn=(INSfp*0.9)-   80. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*1.1)    and INSfn=0 units/hour-   81. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.01*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=(Dexfp*1.1)    and INSfn=(INSfp*0.85)-   82. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=(Dexfp*1.1) and INSfn=(INSfp*0.9)-   83. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧−2 mg/dL) and (Xa−Xb≦3 mg/dL) and (Dexfp>0 mL/hour) and    (INSfp>0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   84. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧3 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour)    and (INSfp>0 units/hour) then Dexfn=0 mL/hour and INSfn=(INSfp*1.05)-   85. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧3 mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (INSfp>0    units/hour) then Dexfn=(Dexfp*0.95) and INSfn=(INSfp*1.05)-   86. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour)    and (INSfp=0 units/hour) then Dexfn=(Dexfp*1.5) and INSfn=INSfp-   87. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt)    mL/hour) and (INSfp=0 units/hour) then Dexfn=(Dexfp*1.25) and    INSfn=INSfp-   88. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−2 mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp=0    units/hour) then Dexfn=(Dexfp*1.1) and INSfn=INSfp-   89. If (Xa≦Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧−2 mg/dL) and (Xa−Xb≦3 mg/dL) and (Dexfp>0 mL/hour) and    (INSfp=0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   90. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧3 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour)    and (INSfp=0 units/hour) then Dexfn=0 mL/hour and INSfn=(0.01*Wt)    units/hour-   91. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧3 mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (INSfp=0    units/hour) then Dexfn=(Dexfp*0.95) and INSfn=(0.01*Wt) units/hour-   92. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≦−3 mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=(2/X*Wt) mL/hour and INSfn=INSfp-   93. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧−3 mg/dL) and (Xa−Xb≦3 mg/dL) and (Dexfp=0 mL/hour) and    (INSfp=0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   94. If (Xa≧Xmin mg/dL) and (Xa<(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa−Xb≧3 mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn=(0.01*Wt) units/hour-   95. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and (Xa<(Xmin+2(Xmax−Xmin)/3)    mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=Dexfp and    INSfn=0 units/hour-   96. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and (Xa<(Xmin+2(Xmax−Xmin)/3)    mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp=0 mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*0.9)-   97. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and (Xa<(Xmin+2(Xmax−Xmin)/3)    mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp=0 mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.95)-   98. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and (Xa<(Xmin+2(Xmax−Xmin)/3)    mg/dL) and (Xa−Xb≧−3 mg/dL) and (Xa−Xb≦3 mg/dL) and (Dexfp=0    mL/hour) and (INSfp>0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   99. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and (Xa<(Xmin+2(Xmax−Xmin)/3)    mg/dL) and (Xa−Xb≧3 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*1.5)-   100. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and (Dexfp=0    mL/hour) and (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.15)-   101. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and (Dexfp=0    mL/hour) and (INSfp>(0.1*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*1.1)-   102. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp>0    mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour)    then Dexfn=Dexfp and INSfn=0 units/hour-   103. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp>0    mL/hour) and (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.9)-   104. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp>0    mL/hour) and (INSfp>(0.1*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*0.95)-   105. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb>−3 mg/dL) and (Xa−Xb≦3    mg/dL) and (Dexfp>0 mL/hour) and (INSfp>0 units/hour) then    Dexfn=Dexfp and INSfn=INSfp-   106. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.5)-   107. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp>(0.01*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.15)-   108. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=0 mL/hour and INSfn=(INSfp*1.05)-   109. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and    (Dexfp>(1/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*0.85)    and INSfn=(INSfp*1.5)-   110. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and    (Dexfp>(1/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=(Dexfp*0.85) and INSfn=(INSfp*1.15)-   111. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and    (Dexfp>(1/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*0.85) and    INSfn=(INSfp*1.05)-   112. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and    (Dexfp>(6/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*0.9) and    INSfn=(INSfp*1.5)-   113. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and    (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦0.1*Wt) units/hour) then Dexfn=(Dexfp*0.9) and    INSfn=(INSfp*1.15)-   114. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and    (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=(Dexfp*0.9) and INSfn=(INSfp*1.05)-   115. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≦−3 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.3) and INSfn=INSfp-   116. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≦−3 mg/dL) and    (Dexfp>(1/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and (INSfp=0    units/hour) then Dexfn=(Dexfp*1.1) and INSfn=INSfp-   117. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≦−3 mg/dL) and    (Dexfp>(6/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*1.05) and INSfn=INSfp-   118. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb>−3 mg/dL) and (Xa−Xb≦3    mg/dL) and (Dexfp>0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn=INSfp-   119. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=0 mL/hour and INSfn=(0.02*Wt) units/hour-   120. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧3 mg/dL) and    (Dexfp>(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*0.9) and INSfn=(0.02*Wt) units/hour-   121. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb<2 mg/dL) and (Dexfp=0    mL/hour) and (INSfp=0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   122. If (Xa≧(Xmin+(Xmax−Xmin)/3) mg/dL) and    (Xa<(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa−Xb≧2 mg/dL) and (Dexfp=0    mL/hour) and (INSfp=0 units/hour) then Dexfn=Dexfp and    INSfn=(0.02*Wt) units/hour-   123. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≦−5 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=Dexfp and INSfn=0 units/hour-   124. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≦−5 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.01*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and    INSfn (INSfp*0.85)-   125. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≦−5 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.9)-   126. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb>−5 mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp=0 mL/hour) and    (INSfp>0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   127. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=Dexfp and INSfn: (INSfp*1.5)-   128. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.02*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*1.15)-   129. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.05)-   130. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≦−5 mg/dL) and (Dexfp>0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=Dexfp and INSfn=0 units/hour-   131. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≦−5 mg/dL) and (Dexfp>0 mL/hour) and (INSfp>(0.01*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.95)-   132. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧−5 mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp>0 mL/hour) and    (INSfp>0 units/hour) then Dexfn=Dexfp and INSfn=INSfp-   133. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour)    and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour) then    Dexfn=0 mL/hour and INSfn=(INSfp*1.5)-   134. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(I/X*Wt) mL/hour)    and (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour)    then Dexfn=0 mL/hour and INSfn=(INSfp*1.15)-   135. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour)    and (INSfp>(0.1*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.05)-   136. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt)    mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt) units/hour)    then Dexfn (Dexfp*0.8) and INSfn=(INSfp*1.5)-   137. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>(i/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt)    mL/hour) and (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt)    units/hour) then Dexfn=(Dexfp*0.8) and INSfn=(INSfp*1.15)-   138. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt)    mL/hour) and (INSfp>(0.1*Wt) units/hour) then Dexfn=(Dexfp*0.8) and    INSfn=(INSfp*1.05)-   139. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*0.85)    and INSfn=(INSfp*1.5)-   140. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.01*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=(Dexfp*0.85)    and INSfn=(INSfp*1.15)-   141. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=(Dexfp*0.85) and INSfn=(INSfp*1.05)-   142. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≦−3 mg/dL) and (Dexfp>0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn=INSfp-   143. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb>−3 mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp>0 mL/hour) and    (Dexfp≦(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then Dexfn=0    mL/hour and INSfn=INSfp-   144. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb>−3 mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp>(1/X*Wt) mL/hour)    and (INSfp=0 units/hour) then Dexfn=(Dexfp*0.95) and INSfn=INSfp-   145. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour)    and (INSfp=0 units/hour) then Dexfn=0 mL/hour and INSfn=(0.02*Wt)    units/hour-   146. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp>(i/X*Wt) mL/hour) and (INSfp=0    units/hour) then Dexfn=(Dexfp*0.9) and INSfn=(0.02*Wt; units/hour-   147. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≦0 mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn=INSfp-   148. If (Xa≧(Xmin+2(Xmax−Xmin)/3) mg/dL) and (Xa<Xmax mg/dL) and    (Xa−Xb≧0 mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn (0.02*Wt) units/hour-   149. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≦−4    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.9)-   150. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≦−4    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*0.95)-   151. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb>−4    mg/dL) and (Xa−Xb≦1 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.02*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*1.3)-   152. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb>−4    mg/dL) and (Xa−Xb≦1 mg/dL) and (Dexfp=0 mL/hour) and    (INSfp>(0.02*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*1.15)-   153. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb>−4    mg/dL) and (Xa−Xb≦1 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.05)-   154. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧1 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.01*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.5)-   155. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧1 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.3)-   156. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧1 mg/dL)    and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*1.1)-   157. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≦−4    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and    (INSfp>0 units/hour) then Dexfn=0 mL/hour and INSfn=INSfp-   158. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≦−4    mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (INSfp>0 units/hour) then    Dexfn=(Dexfp*0.95) and INSfn=(INSfp*1.05)-   159. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb>−4    mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt)    mL/hour) and (INSfp>0 units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.05)-   160. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb>−4    mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (INSfp>0    units/hour) then Dexfn=(Dexfp*0.9) and INSfn=(INSfp*1.05)-   161. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.01*Wt) units/hour) then Dexfn=0 mL/hour    and INSfn=(INSfp*1.5)-   162. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and    (INSfp>(0.01*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=0 mL/hour and INSfn=(INSfp*1.3)-   163. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.1)-   164. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>(1/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.01*Wt) units/hour) then Dexfn=(Dexfp*0.8) and    INSfn=(INSfp*1.5)-   165. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>(1/X*Wt) mL/hour) and (INSfp>(0.01*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=(Dexfp*0.8) and    INSfn=(INSfp*1.3)-   166. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>(1/X*Wt) mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=(Dexfp*0.8) and INSfn=(INSfp*1.1)-   167. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≦0 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp=0    units/hour) then Dexfn=0 mL/hour and INSfn=INSfp-   168. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≦0 mg/dL)    and (Dexfp>(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*0.9) mL/hour and INSfn=INSfp-   169. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp=0    units/hour) then Dexfn=0 mL/hour and INSfn=(0.02*Wt) units/hour-   170. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≧0 mg/dL)    and (Dexfp>(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*0.8) mL/hour and INSfn=(0.02*Wt) units/hour-   171. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb≦−3    mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn=INSfp-   172. If (Xa≧Xmax mg/dL) and (Xa<(Xmax+10) mg/dL) and (Xa−Xb>−3    mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn=(0.02*Wt) units/hour-   173. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≦−6    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and INSfn=(INSfp*0.9)-   174. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≦−6    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*0.95)-   175. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Xa−Xb<0 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0    units/hour) and (INSfp≦(0.02*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*1.4)-   176. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp=0 mL/hour) and    (INSfp>(0.02*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*1.2)-   177. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Xa−Xb≦0 mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.1)-   178. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≧0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.5)-   179. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≧0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.02*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.3)-   180. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≧0    mg/dL) and (Dexfp=0 mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=Dexfp and INSfn=(INSfp*1.1)-   181. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≦−6    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour: and    (INSfp>0 units/hour) then Dexfn=0 mL/hour and INSfn=(INSfp*1.1)-   182. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≦−6    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (Dexfp≦(6/X*Wt) mL/hour) and    (INSfp>0 units/hour) then Dexfn=(Dexfp*0.8) and INSfn=(INSfp*1.1)-   183. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≦−6    mg/dL) and (Dexfp>(6/X*Wt) mL/hour) and (INSfp>0 units/hour) then    Dexfn=(Dexfp*0.9) and INSfn: (INSfp*1.1)-   184. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp>0 units/hour) and (INSfp≦(0.02*Wt) units/hour) then Dexfn=0    mL/hour and INSfn=(INSfp*1.5)-   185. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour; and    (INSfp>(0.02*Wt) units/hour) and (INSfp≦(0.1*Wt) units/hour) then    Dexfn=0 mL/hour and INSfn=: (INSfp*1.3)-   186. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and    (INSfp>(0.1*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.1)-   187. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=(Dexfp*0.8) and    INSfn=(INSfp*1.5)-   188. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (INSfp>(0.02*Wt) units/hour)    and (INSfp≦(0.1*Wt) units/hour) then Dexfn=(Dexfp*0.8) and INSfn    (INSfp*1.3)-   189. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−6    mg/dL) and (Dexfp>(2/X*Wt) mL/hour) and (INSfp>(0.1*Wt) units/hour)    then Dexfn=(Dexfp*0.8) and INSfn=(INSfp*1.1)-   190. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≦1    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour; and    (INSfp=0 units/hour) then Dexfn=0 mL/hour and INSfn=(0.03*Wt)    units/hour-   191. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≦1    mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*0.8) mL/hour and INSfn=(0.03*Wt) units/hour-   192. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≧1    mg/dL) and (Dexfp>0 mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and    (INSfp=0 units/hour) then Dexfn=0 mL/hour and INSfn=(0.03*Wt)    units/hour-   193. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb≧1    mg/dL) and (Dexfp>(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*0.7) mL/hour and INSfn=(0.03*Wt) units/hour-   194. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb<−3    mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then    Dexfn=Dexfp and INSfn=(0.02*Wt) units/hour-   195. If (Xa≧(Xmax+10) mg/dL) and (Xa<(Xmax+30) mg/dL) and (Xa−Xb>−3    mg/dL) and (Dexfp=0 mL/hour) and (INSfp=0 units/hour) then Dexfn=0    mL/hour and INSfn=(0.03*Wt) units/hour-   196. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb<−15 mg/dL) and (Dexfp=0    mL/hour) and (INSfp>0 units/hour) then Dexfn=0 mL/hour and    INSfn=INSfp-   197. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp=0    mL/hour) and (INSfp>0 units/hour) and (INSfp≦(0.02*Wt) units/hour)    then Dexfn=Dexfp and INSfn (INSfp*1.6)-   198. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp=0    mL/hour) and (INSfp>(0.02*Wt) units/hour) and (INSfp≦(0.1*Wt)    units/hour) then Dexfn=Dexfp and INSfn=(INSfp*1.4)-   199. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp=0    mL/hour) and (INSfp>(0.1*Wt) units/hour) then Dexfn=Dexfp and    INSfn=(INSfp*1.1)-   200. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.5)-   201. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>(0.02*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.2)-   202. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=0 mL/hour and INSfn=(INSfp*1.05)-   203. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and    (Dexfp>(2/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=(Dexfp*0.9) and    INSfn=(INSfp*1.5)-   204. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and    (Dexfp>(2/X*Wt) mL/hour) and (INSfp>(0.02*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn=(Dexfp*0.9) and    INSfn=(INSfp*1.2)-   205. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and    (Dexfp>(2/X*Wt) mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=(Dexfp*0.9) and INSfn=(INSfp*1.05)-   206. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.7)-   207. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>(0.02*Wt)    units/hour) and (INSfp≦(0.1*Wt) units/hour) then Dexfn=0 mL/hour and    INSfn=(INSfp*1.3)-   208. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp>(0.1*Wt)    units/hour) then Dexfn=0 mL/hour and INSfn=(INSfp*1.1)-   209. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and    (Dexfp>(2/X*Wt) mL/hour) and (INSfp>0 units/hour) and    (INSfp≦(0.02*Wt) units/hour) then Dexfn=(Dexfp*0.Xmin) and    INSfn=(INSfp*1.7)-   210. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and    (Dexfp>(2/X*Wt) mL/hour) and (INSfp>(0.02*Wt) units/hour) and    (INSfp≦(0.1*Wt) units/hour) then Dexfn (Dexfp*0.Xmin) and    INSfn=(INSfp*1.3)-   211. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and    (Dexfp>(2/X*Wt) mL/hour) and (INSfp>(0.1*Wt) units/hour) then    Dexfn=(Dexfp*0.75) and INSfn=(INSfp*1.1)-   212. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=0 mL/hour and INSfn (0.01*Wt) units/hour-   213. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and    (Dexfp>(1/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*0.9) and INSfn=(0.01*Wt) units/hour-   214. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp>0    mL/hour) and (Dexfp≦(2/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=0 mL/hour and INSfn=(0.03*Wt) units/hour-   215. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and    (Dexfp>(2/X*Wt) mL/hour) and (INSfp=0 units/hour) then    Dexfn=(Dexfp*0.7) and INSfn=(0.03*Wt) units/hour-   216. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb≦−15 mg/dL) and (Dexfp=0    mL/hour) and (INSfp=0 units/hour) then Dexfn=Dexfp and    INSfn=(0.01*Wt) units/hour-   217. If (Xa≧(Xmax+30) mg/dL) and (Xa−Xb>−15 mg/dL) and (Dexfp=0    mL/hour) and (INSfp=0 units/hour) then Dexfn=Dexfp and    INSfn=(0.03*Wt) units/hour-   218. If (Xa≧(Xmax+20 mg/dL) and (Xa<(Xmax+50 mg/dL) and (Xa−Xb>−5    mg/dL) then (give bolus dose insulin=(0.04 units*Wt) over 10    minutes) in addition to INSfn as calculated by algorithm.-   219. If (Xa≧(Xmax+50) mg/dL) and (Xa<(Xmax+90) mg/dL) and (Xa−Xb>−15    mg/dL) then (give bolus dose insulin=(0.04 units*Wt) over 10    minutes) in addition to INSfn as calculated by algorithm-   220. If (Xa≧(Xmax+90) mg/dL) and (Xa−Xb>−20 mg/dL) then (give bolus    dose insulin=(0.08 units*Wt) over 10 minutes) in addition to INSfn    as calculated by algorithm-   221. If (Dexfn≧DexSh) then Dexfn=DexSh and activate alarm “Maximum    Dextrose Infusion Rate”-   222. If (INSfn≧INSSh) then INSfn=INSSh and activate alarm “Maximum    Insulin Infusion Rate”-   223. MIVFR=TIVFR−(Dexfn+(INSfn*Conc⁻¹)

Glucose Algorithm Table AND AND AND AND Xa Xa − Xb Dexfp INSfp Dexfn =INSfn = (mg/dL) (mg/dL) (mL/hr) (units/hr) THEN (mL/hr) (units/hr) 1 Xa− Xmin < −10 Dexfp = 0 0 < INSfp 6/C * Wt INSfp * 0.5 2 Xa − Xmin < −10Xa − Xb < −3 0 < Dexfp ≦ 2/C * Wt 0 < INSfp ≦ 0.05 * Wt Dexfp * 1.7 0 3Xa − Xmin < −10 Xa − Xb < −3 0 < Dexfp ≦ 2/C * Wt INSfp > 0.05 * WtDexfp * 1.7 INSfp * 0.85 4 Xa − Xmin < −10 Xa − Xb < −3 2/C * Wt < Dexfp≦ 6/C * Wt 0 < INSfp < 0.05 * Wt Dexfp * 1.2 0 5 Xa − Xmin < −10 Xa − Xb< −3 2/C * Wt < Dexfp ≦ 6/C * Wt INSfp ≧ 0.05 * Wt Dexfp * 1.2 INSfp *0.85 6 Xa − Xmin < −10 Xa − Xb < −3 6/C * Wt < Dexfp 0 < INSfp < 0.05 *Wt Dexfp * 1.1 0 7 Xa − Xmin < −10 Xa − Xb < −3 6/C * Wt < Dexfp INSfp ≧0.05 * Wt Dexfp * 1.1 INSfp * 0.85 8 Xa − Xmin < −10 −3 ≦ Xa − Xb 0 <Dexfp ≦ 2/C * Wt 0 < INSfp ≦ 0.02 * Wt Dexfp * 1.3 0 9 Xa − Xmin < −10−3 ≦ Xa − Xb 0 < Dexfp ≦ 2/C * Wt 0.02 * Wt < INSfp Dexfp * 1.3 INSfp *0.85 10 Xa − Xmin < −10 −3 ≦ Xa − Xb 2/C * Wt < Dexfp ≦ 6/C * Wt 0 <INSfp ≦ 0.02 * Wt Dexfp * 1.2 0 11 Xa − Xmin < −10 −3 ≦ Xa − Xb 2/C * Wt< Dexfp ≦ 6/C * Wt 0.02 * Wt < INSfp Dexfp * 1.2 INSfp * 0.85 12 Xa −Xmin < −10 −3 ≦ Xa − Xb 6/C * Wt < Dexfp 0 < INSfp ≦ 0.02 * Wt Dexfp *1.1 0 13 Xa − Xmin < −10 −3 ≦ Xa − Xb 6/C * Wt < Dexfp 0.02 * Wt < INSfpDexfp * 1.1 INSfp * 0.75 14 Xa − Xmin < −10 Xa − Xb < −3 0 < Dexfp ≦2/C * Wt INSfp = 0 Dexfp * 1.7 INSfp 15 Xa − Xmin < −10 Xa − Xb < −32/C * Wt < Dexfp ≦ 6/C * Wt INSfp = 0 Dexfp * 1.4 INSfp 16 Xa − Xmin <−10 Xa − Xb < −3 6/C * Wt < Dexfp INSfp = 0 Dexfp * 1.2 INSfp 17 Xa −Xmin < −10 −3 ≦ Xa − Xb 0 < Dexfp ≦ 2/C * Wt INSfp = 0 Dexfp * 1.5 INSfp18 Xa − Xmin < −10 −3 ≦ Xa − Xb 2/C * Wt < Dexfp ≦ 6/C * Wt INSfp = 0Dexfp * 1.3 INSfp 19 Xa − Xmin < −10 −3 ≦ Xa − Xb 6/C * Wt < Dexfp INSfp= 0 Dexfp * 1.2 INSfp 20 Xa − Xmin < −10 Dexfp = 0 INSfp = 0 6/C * WtINSfp 21 −10 ≦ Xa − Xmin < −5 Xa − Xb < 0 Dexfp = 0 0 < INSfp ≦ 0.01 *Wt 3/C * Wt 0 22 −10 ≦ Xa − Xmin < −5 Xa − Xb < 0 Dexfp = 0 0.01 * Wt <INSfp ≦ 0.1 * Wt 3/C * Wt INSfp * 0.85 23 −10 ≦ Xa − Xmin < −5 Xa − Xb <0 Dexfp = 0 0.1 * Wt < INSfp 3/C * Wt INSfp * 0.9 24 −10 ≦ Xa − Xmin <−5 0 ≦ Xa − Xb Dexfp = 0 0 < INSfp ≦ 0.01 * Wt Dexfp 0 25 −10 ≦ Xa −Xmin < −5 0 ≦ Xa − Xb Dexfp = 0 0.01 * Wt < INSfp ≦ 0.1 * Wt DexfpINSfp * 0.9 26 −10 ≦ Xa − Xmin < −5 0 ≦ Xa − Xb Dexfp = 0 0.1 * Wt <INSfp Dexfp INSfp * 0.85 27 −10 ≦ Xa − Xmin < −5 Xa − Xb < −3 0 < Dexfp≦ 2/C * Wt 0 < INSfp ≦ 0.01 * Wt Dexfp * 1.5 0 28 −10 ≦ Xa − Xmin < −5Xa − Xb < −3 0 < Dexfp ≦ 2/C * Wt 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp *1.5 INSfp * 0.8 29 −10 ≦ Xa − Xmin < −5 Xa − Xb < −3 0 < Dexfp ≦ 2/C *Wt 0.1 * Wt < INSfp Dexfp * 1.5 INSfp * 0.9 30 −10 ≦ Xa − Xmin < −5 Xa −Xb < −3 2/C * Wt < Dexfp ≦ 6/C * Wt 0 < INSfp ≦ 0.01 * Wt Dexfp * 1.3 031 −10 ≦ Xa − Xmin < −5 Xa − Xb < −3 2/C * Wt < Dexfp ≦ 6/C * Wt 0.01 *Wt < INSfp ≦ 0.1 * Wt Dexfp * 1.3 INSfp * 0.8 32 −10 ≦ Xa − Xmin < −5 Xa− Xb < −3 2/C * Wt < Dexfp ≦ 6/C * Wt 0.1 * Wt < INSfp Dexfp * 1.3INSfp * 0.9 33 −10 ≦ Xa − Xmin < −5 Xa − Xb < −3 6/C * Wt < Dexfp 0 <INSfp ≦ 0.01 * Wt Dexfp * 1.2 0 34 −10 ≦ Xa − Xmin < −5 Xa − Xb < −36/C * Wt < Dexfp 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 1.1 INSfp * 0.8 35−10 ≦ Xa − Xmin < −5 Xa − Xb < −3 6/C * Wt < Dexfp 0.1 * Wt < INSfpDexfp * 1.1 INSfp * 0.9 36 −10 ≦ Xa − Xmin < −5 −3 ≦ Xa − Xb ≦ 1 0 <Dexfp 0 < INSfp ≦ 0.01 * Wt Dexfp * 1.1 0 37 −10 ≦ Xa − Xmin < −5 −3 ≦Xa − Xb ≦ 1 0 < Dexfp 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 1.1 INSfp *0.85 38 −10 ≦ Xa − Xmin < −5 −3 ≦ Xa − Xb ≦ 1 0 < Dexfp 0.1 * Wt < INSfpDexfp * 1.1 INSfp * 0.95 39 −10 ≦ Xa − Xmin < −5 1 < Xa − Xb 0 < Dexfp 0< INSfp Dexfp * 1.1 INSfp * 0.95 40 −10 ≦ Xa − Xmin < −5 Xa − Xb < −1 0< Dexfp ≦ 2/C * Wt INSfp = 0 Dexfp * 1.5 INSfp 41 −10 ≦ Xa − Xmin < −5Xa − Xb < −1 2/C * Wt < Dexfp ≦ 6/C * Wt INSfp = 0 Dexfp * 1.3 INSfp 42−10 ≦ Xa − Xmin < −5 Xa − Xb < −1 6/C * Wt < Dexfp INSfp = 0 Dexfp * 1.1INSfp 43 −10 ≦ Xa − Xmin < −5 −1 ≦ Xa − Xb 0 < Dexfp INSfp = 0 Dexfp *1.1 INSfp 44 −10 ≦ Xa − Xmin < −5 Xa − Xb < −1 Dexfp = 0 INSfp = 0 3/C *Wt INSfp 45 −10 ≦ Xa − Xmin < −5 −1 ≦ Xa − Xb Dexfp = 0 INSfp = 0 2/C *Wt INSfp 46  −5 ≦ Xa − Xmin < 0 Xa − Xb < −2 Dexfp = 0 0 < INSfp ≦0.01 * Wt 2/C * Wt 0 47  −5 ≦ Xa − Xmin < 0 Xa − Xb < −2 Dexfp = 00.01 * Wt < INSfp ≦ 0.1 * Wt 2/C * Wt INSfp * 0.8 48  −5 ≦ Xa − Xmin < 0Xa − Xb < −2 Dexfp = 0 0.1 * Wt < INSfp 2/C * Wt INSfp * 0.9 49  −5 ≦ Xa− Xmin < 0 −2 ≦ Xa − Xb Dexfp = 0 0 < INSfp ≦ 0.01 * Wt Dexfp 0 50  −5 ≦Xa − Xmin < 0 −2 ≦ Xa − Xb Dexfp = 0 0.01 * Wt < INSfp ≦ 0.1 * Wt DexfpINSfp * 0.85 51  −5 ≦ Xa − Xmin < 0 −2 ≦ Xa − Xb Dexfp = 0 0.1 * Wt <INSfp Dexfp INSfp * 0.95 52  −5 ≦ Xa − Xmin < 0 Xa − Xb < −2 0 < Dexfp ≦2/C * Wt 0 < INSfp ≦ 0.01 * Wt Dexfp * 1.5 0 53  −5 ≦ Xa − Xmin < 0 Xa −Xb < −2 0 < Dexfp ≦ 2/C * Wt 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 1.5INSfp * 0.85 54  −5 ≦ Xa − Xmin < 0 Xa − Xb < −2 0 < Dexfp ≦ 2/C * Wt0.1 * Wt < INSfp Dexfp * 1.5 INSfp * 0.9 55  −5 ≦ Xa − Xmin < 0 Xa − Xb< −2 2/C * Wt < Dexfp ≦ 6/C * Wt 0 < INSfp ≦ 0.01 * Wt Dexfp * 1.25 0 56 −5 ≦ Xa − Xmin < 0 Xa − Xb < −2 2/C * Wt < Dexfp ≦ 6/C * Wt 0.01 * Wt <INSfp ≦ 0.1 * Wt Dexfp * 1.25 INSfp * 0.85 57  −5 ≦ Xa − Xmin < 0 Xa −Xb < −2 2/C * Wt < Dexfp ≦ 6/C * Wt 0.1 * Wt < INSfp Dexfp * 1.25INSfp * 0.9 58  −5 ≦ Xa − Xmin < 0 Xa − Xb < −2 6/C * Wt < Dexfp 0 <INSfp ≦ 0.01 * Wt Dexfp * 1.1 0 59  −5 ≦ Xa − Xmin < 0 Xa − Xb < −26/C * Wt < Dexfp 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 1.1 INSfp * 0.8560  −5 ≦ Xa − Xmin < 0 Xa − Xb < −2 6/C * Wt < Dexfp 0.1 * Wt < INSfpDexfp * 1.1 INSfp * 0.9 61  −5 ≦ Xa − Xmin < 0 −2 ≦ Xa − Xb 0 < Dexfp 0< INSfp ≦ 0.01 * Wt Dexfp 0 62  −5 ≦ Xa − Xmin < 0 −2 ≦ Xa − Xb 0 <Dexfp 0.01 * Wt < INSfp Dexfp INSfp * 0.95 63  −5 ≦ Xa − Xmin < 0 Xa −Xb < −1 0 < Dexfp ≦ 2/C * Wt INSfp = 0 Dexfp * 1.5 INSfp 64  −5 ≦ Xa −Xmin < 0 Xa − Xb < −1 2/C * Wt < Dexfp ≦ 6/C * Wt INSfp = 0 Dexfp * 1.25INSfp 65  −5 ≦ Xa − Xmin < 0 Xa − Xb < −1 6/C * Wt < Dexfp INSfp = 0Dexfp * 1.1 INSfp 66  −5 ≦ Xa − Xmin < 0 −1 ≦ Xa − Xb 0 < Dexfp INSfp =0 Dexfp INSfp 67  −5 ≦ Xa − Xmin < 0 Xa − Xb < −1 Dexfp = 0 INSfp = 02/C * Wt INSfp 68  −5 ≦ Xa − Xmin < 0 −1 ≦ Xa − Xb Dexfp = 0 INSfp = 0Dexfp INSfp 69 0 ≦ Xa − Xmin < Xa − Xb ≦ −2 Dexfp = 0 0 < INSfp ≦ 0.01 *Wt Dexfp 0 (Xmax − Xmin)/3 70 0 ≦ Xa − Xmin < Xa − Xb ≦ −2 Dexfp = 00.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 0.85 (Xmax − Xmin)/3 71 0 ≦Xa − Xmin < Xa − Xb ≦ −2 Dexfp = 0 0.1 * Wt < INSfp Dexfp INSfp * 0.9(Xmax − Xmin)/3 72 0 ≦ Xa − Xmin < −2 < Xa − Xb ≦ 3 Dexfp = 0 0 < INSfpDexfp INSfp (Xmax − Xmin)/3 73 0 ≦ Xa − Xmin < 3 < Xa − Xb Dexfp = 0 0 <INSfp Dexfp INSfp * 1.05 (Xmax − Xmin)/3 74 0 ≦ Xa − Xmin < Xa − Xb ≦ −20 < Dexfp ≦ 2/C * Wt 0 < INSfp ≦ 0.01 * Wt Dexfp * 1.5 0 (Xmax − Xmin)/375 0 ≦ Xa − Xmin < Xa − Xb ≦ −2 0 < Dexfp ≦ 2/C * Wt 0.01 * Wt < INSfp ≦0.1 * Wt Dexfp * 1.5 INSfp * 0.85 (Xmax − Xmin)/3 76 0 ≦ Xa − Xmin < Xa− Xb ≦ −2 0 < Dexfp ≦ 2/C * Wt 0.1 * Wt < INSfp Dexfp * 1.5 INSfp * 0.9(Xmax − Xmin)/3 77 0 ≦ Xa − Xmin < Xa − Xb ≦ −2 2/C * Wt < Dexfp ≦ 6/C *Wt 0 < INSfp ≦ 0.01 * Wt Dexfp * 1.25 0 (Xmax − Xmin)/3 78 0 ≦ Xa − Xmin< Xa − Xb ≦ −2 2/C * Wt < Dexfp ≦ 6/C * Wt 0.01 * Wt < INSfp ≦ 0.1 * WtDexfp * 1.25 INSfp * 0.85 (Xmax − Xmin)/3 79 0 ≦ Xa − Xmin < Xa − Xb ≦−2 2/C * Wt < Dexfp ≦ 6/C * Wt 0.1 * Wt < INSfp Dexfp * 1.25 INSfp * 0.9(Xmax − Xmin)/3 80 0 ≦ Xa − Xmin < Xa − Xb ≦ −2 6/C * Wt < Dexfp 0 <INSfp ≦ 0.01 * Wt Dexfp * 1.1 0 (Xmax − Xmin)/3 81 0 ≦ Xa − Xmin < Xa −Xb ≦ −2 6/C * Wt < Dexfp 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 1.1INSfp * 0.85 (Xmax − Xmin)/3 82 0 ≦ Xa − Xmin < Xa − Xb ≦ −2 6/C * Wt <Dexfp 0.1 * Wt < INSfp Dexfp * 1.1 INSfp * 0.9 (Xmax − Xmin)/3 83 0 ≦ Xa− Xmin < −2 < Xa − Xb ≦ 3 0 < Dexfp 0 < INSfp Dexfp INSfp (Xmax −Xmin)/3 84 0 ≦ Xa − Xmin < 3 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt 0 < INSfp 0INSfp * 1.05 (Xmax − Xmin)/3 85 0 ≦ Xa − Xmin < 3 < Xa − Xb 1/C * Wt <Dexfp 0 < INSfp Dexfp * 0.95 INSfp * 1.05 (Xmax − Xmin)/3 86 0 ≦ Xa −Xmin < Xa − Xb ≦ −2 0 < Dexfp ≦ 2/C * Wt INSfp = 0 Dexfp * 1.5 INSfp(Xmax − Xmin)/3 87 0 ≦ Xa − Xmin < Xa − Xb ≦ −2 2/C * Wt < Dexfp ≦ 6/C *Wt INSfp = 0 Dexfp * 1.25 INSfp (Xmax − Xmin)/3 88 0 ≦ Xa − Xmin < Xa −Xb ≦ −2 6/C * Wt < Dexfp INSfp = 0 Dexfp * 1.1 INSfp (Xmax − Xmin)/3 890 ≦ Xa − Xmin < −2 < Xa − Xb ≦ 3 0 < Dexfp INSfp = 0 Dexfp INSfp (Xmax −Xmin)/3 90 0 ≦ Xa − Xmin < 3 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt INSfp = 0 00.01 * Wt (Xmax − Xmin)/3 91 0 ≦ Xa − Xmin < 3 < Xa − Xb 1/C * Wt <Dexfp INSfp = 0 Dexfp * 0.95 0.01 * Wt (Xmax − Xmin)/3 92 0 ≦ Xa − Xmin< Xa − Xb ≦ −3 Dexfp = 0 INSfp = 0 2/C * Wt INSfp (Xmax − Xmin)/3 93 0 ≦Xa − Xmin < −3 < Xa − Xb ≦ 3 Dexfp = 0 INSfp = 0 Dexfp INSfp (Xmax −Xmin)/3 94 0 ≦ Xa − Xmin < 3 < Xa − Xb Dexfp = 0 INSfp = 0 Dexfp 0.01 *Wt (Xmax − Xmin)/3 95 (Xmax − Xmin)/3 ≦ Xa − Xb ≦ −3 Dexfp = 0 0 < INSfp≦ 0.01 * Wt Dexfp 0 Xa − Xmin < 2(Xmax − Xmin)/3 96 (Xmax − Xmin)/3 ≦ Xa− Xb ≦ −3 Dexfp = 0 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 0.9 Xa −Xmin < 2(Xmax − Xmin)/3 97 (Xmax − Xmin)/3 ≦ Xa − Xb ≦ −3 Dexfp = 00.1 * Wt < INSfp Dexfp INSfp * 0.95 Xa − Xmin < 2(Xmax − Xmin)/3 98(Xmax − Xmin)/3 ≦ −3 < Xa − Xb ≦ 3 Dexfp = 0 0 < INSfp Dexfp INSfp Xa −Xmin < 2(Xmax − Xmin)/3 99 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb Dexfp = 0 0 <INSfp ≦ 0.01 * Wt Dexfp INSfp * 1.5 Xa − Xmin < 2(Xmax − Xmin)/3 100(Xmax − Xmin)/3 ≦ 3 < Xa − Xb Dexfp = 0 0.01 * Wt < INSfp ≦ 0.1 * WtDexfp INSfp * 1.15 Xa − Xmin < 2(Xmax − Xmin)/3 101 (Xmax − Xmin)/3 ≦ 3< Xa − Xb Dexfp = 0 0.1 * Wt < INSfp Dexfp INSfp * 1.1 Xa − Xmin <2(Xmax − Xmin)/3 102 (Xmax − Xmin)/3 ≦ Xa − Xb ≦ −3 0 < Dexfp 0 < INSfp≦ 0.01 * Wt Dexfp 0 Xa − Xmin < 2(Xmax − Xmin)/3 103 (Xmax − Xmin)/3 ≦Xa − Xb ≦ −3 0 < Dexfp 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 0.9 Xa− Xmin < 2(Xmax − Xmin)/3 104 (Xmax − Xmin)/3 ≦ Xa − Xb ≦ −3 0 < Dexfp0.1 * Wt < INSfp Dexfp INSfp * 0.95 Xa − Xmin < 2(Xmax − Xmin)/3 105(Xmax − Xmin)/3 ≦ −3 < Xa − Xb ≦ 3 0 < Dexfp 0 < INSfp Dexfp INSfp Xa −Xmin < 2(Xmax − Xmin)/3 106 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb 0 < Dexfp ≦1/C * Wt 0 < INSfp ≦ 0.01 * Wt 0 INSfp * 1.5 Xa − Xmin < 2(Xmax −Xmin)/3 107 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt 0.01 * Wt< INSfp ≦ 0.1 * Wt 0 INSfp * 1.15 Xa − Xmin < 2(Xmax − Xmin)/3 108 (Xmax− Xmin)/3 ≦ 3 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt 0.1 * Wt < INSfp 0 INSfp *1.05 Xa − Xmin < 2(Xmax − Xmin)/3 109 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb1/C * Wt < Dexfp ≦ 6/C * Wt 0 < INSfp ≦ 0.01 * Wt Dexfp * 0.85 INSfp *1.5 Xa − Xmin < 2(Xmax − Xmin)/3 110 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb 1/C *Wt < Dexfp ≦ 6/C * Wt 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 0.85 INSfp *1.15 Xa − Xmin < 2(Xmax − Xmin)/3 111 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb1/C * Wt < Dexfp ≦ 6/C * Wt 0.1 * Wt < INSfp Dexfp * 0.85 INSfp * 1.05Xa − Xmin < 2(Xmax − Xmin)/3 112 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb 6/C * Wt< Dexfp 0 < INSfp ≦ 0.01 * Wt Dexfp * 0.9 INSfp * 1.5 Xa − Xmin < 2(Xmax− Xmin)/3 113 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb 6/C * Wt < Dexfp 0.01 * Wt <INSfp ≦ 0.1 * Wt Dexfp * 0.9 INSfp * 1.15 Xa − Xmin < 2(Xmax − Xmin)/3114 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb 6/C * Wt < Dexfp 0.1 * Wt < INSfpDexfp * 0.9 INSfp * 1.05 Xa − Xmin < 2(Xmax − Xmin)/3 115 (Xmax −Xmin)/3 ≦ Xa − Xb ≦ −3 0 < Dexfp ≦ 1/C * Wt INSfp = 0 Dexfp * 1.3 INSfpXa − Xmin < 2(Xmax − Xmin)/3 116 (Xmax − Xmin)/3 ≦ Xa − Xb ≦ −3 1/C * Wt< Dexfp ≦ 6/C * Wt INSfp = 0 Dexfp * 1.1 INSfp Xa − Xmin < 2(Xmax −Xmin)/3 117 (Xmax − Xmin)/3 ≦ Xa − Xb ≦ −3 6/C * Wt < Dexfp INSfp = 0Dexfp * 1.05 INSfp Xa − Xmin < 2(Xmax − Xmin)/3 118 (Xmax − Xmin)/3 ≦ −3< Xa − Xb ≦ 3 0 < Dexfp INSfp = 0 Dexfp INSfp Xa − Xmin < 2(Xmax −Xmin)/3 119 (Xmax − Xmin)/3 ≦ 3 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt INSfp = 00 0.02 * Wt Xa − Xmin < 2(Xmax − Xmin)/3 120 (Xmax − Xmin)/3 ≦ 3 < Xa −Xb 1/C * Wt < Dexfp INSfp = 0 Dexfp * 0.9 0.02 * Wt Xa − Xmin < 2(Xmax −Xmin)/3 121 (Xmax − Xmin)/3 ≦ Xa − Xb ≦ −2 Dexfp = 0 INSfp = 0 DexfpINSfp Xa − Xmin < 2(Xmax − Xmin)/3 122 (Xmax − Xmin)/3 ≦ 2 < Xa − XbDexfp = 0 INSfp = 0 Dexfp 0.02 * Wt Xa − Xmin < 2(Xmax − Xmin)/3 1232(Xmax − Xmin)/3 ≦ Xa − Xb ≦ −5 Dexfp = 0 0 < INSfp ≦ 0.01 * Wt Dexfp 0Xa − Xmin < (Xmax − Xmin) 124 2(Xmax − Xmin)/3 ≦ Xa − Xb ≦ −5 Dexfp = 00.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 0.85 Xa − Xmin < (Xmax −Xmin) 125 2(Xmax − Xmin)/3 ≦ Xa − Xb ≦ −5 Dexfp = 0 0.1 * Wt < INSfpDexfp INSfp * 0.9 Xa − Xmin < (Xmax − Xmin) 126 2(Xmax − Xmin)/3 ≦ −5 <Xa − Xb ≦ 0 Dexfp = 0 0 < INSfp Dexfp INSfp Xa − Xmin < (Xmax − Xmin)127 2(Xmax − Xmin)/3 ≦ 0 < Xa − Xb Dexfp = 0 0 < INSfp ≦ 0.02 * Wt DexfpINSfp * 1.5 Xa − Xmin < (Xmax − Xmin) 128 2(Xmax − Xmin)/3 ≦ 0 < Xa − XbDexfp = 0 0.02 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 1.15 Xa − Xmin <(Xmax − Xmin) 129 2(Xmax − Xmin)/3 ≦ 0 < Xa − Xb Dexfp = 0 0.1 * Wt <INSfp Dexfp INSfp * 1.05 Xa − Xmin < (Xmax − Xmin) 130 2(Xmax − Xmin)/3≦ Xa − Xb ≦ −5 0 < Dexfp 0 < INSfp ≦ 0.01 * Wt Dexfp 0 Xa − Xmin < (Xmax− Xmin) 131 2(Xmax − Xmin)/3 ≦ Xa − Xb ≦ −5 0 < Dexfp 0.01 * Wt < INSfpDexfp INSfp * 0.95 Xa − Xmin < (Xmax − Xmin) 132 2(Xmax − Xmin)/3 ≦ −5 <Xa − Xb ≦ 0 0 < Dexfp 0 < INSfp Dexfp INSfp Xa − Xmin < (Xmax − Xmin)133 2(Xmax − Xmin)/3 ≦ 0 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt 0 < INSfp ≦0.01 * Wt 0 INSfp * 1.5 Xa − Xmin < (Xmax − Xmin) 134 2(Xmax − Xmin)/3 ≦0 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt 0.01 * Wt < INSfp ≦ 0.1 * Wt 0 INSfp *1.15 Xa − Xmin < (Xmax − Xmin) 135 2(Xmax − Xmin)/3 ≦ 0 < Xa − Xb 0 <Dexfp ≦ 1/C * Wt 0.1 * Wt < INSfp 0 INSfp * 1.05 Xa − Xmin < (Xmax −Xmin) 136 2(Xmax − Xmin)/3 ≦ 0 < Xa − Xb 1/C * Wt < Dexfp ≦ 6/C * Wt 0 <INSfp ≦ 0.01 * Wt Dexfp * 0.8 INSfp * 1.5 Xa − Xmin < (Xmax − Xmin) 1372(Xmax − Xmin)/3 ≦ 0 < Xa − Xb 1/C * Wt < Dexfp ≦ 6/C * Wt 0.01 * Wt <INSfp ≦ 0.1 * Wt Dexfp * 0.8 INSfp * 1.15 Xa − Xmin < (Xmax − Xmin) 1382(Xmax − Xmin)/3 ≦ 0 < Xa − Xb 1/C * Wt < Dexfp ≦ 6/C * Wt 0.1 * Wt <INSfp Dexfp * 0.8 INSfp * 1.05 Xa − Xmin < (Xmax − Xmin) 139 2(Xmax −Xmin)/3 ≦ 0 < Xa − Xb 6/C * Wt < Dexfp 0 < INSfp ≦ 0.01 * Wt Dexfp *0.85 INSfp * 1.5 Xa − Xmin < (Xmax − Xmin) 140 2(Xmax − Xmin)/3 ≦ 0 < Xa− Xb 6/C * Wt < Dexfp 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 0.85 INSfp *1.15 Xa − Xmin < (Xmax − Xmin) 141 2(Xmax − Xmin)/3 ≦ 0 < Xa − Xb 6/C *Wt < Dexfp 0.1 * Wt < INSfp Dexfp * 0.85 INSfp * 1.05 Xa − Xmin < (Xmax− Xmin) 142 2(Xmax − Xmin)/3 ≦ Xa − Xb ≦ −3 0 < Dexfp INSfp = 0 DexfpINSfp Xa − Xmin < (Xmax − Xmin) 143 2(Xmax − Xmin)/3 ≦ −3 < Xa − Xb ≦ 00 < Dexfp ≦ 1/C * Wt INSfp = 0 0 INSfp Xa − Xmin < (Xmax − Xmin) 1442(Xmax − Xmin)/3 ≦ −3 < Xa − Xb ≦ 0 1/C * Wt < Dexfp INSfp = 0 Dexfp *0.95 INSfp Xa − Xmin < (Xmax − Xmin) 145 2(Xmax − Xmin)/3 ≦ 0 < Xa − Xb0 < Dexfp ≦ 1/C * Wt INSfp = 0 0 0.02 * Wt Xa − Xmin < (Xmax − Xmin) 1462(Xmax − Xmin)/3 ≦ 0 < Xa − Xb 1/C * Wt < Dexfp INSfp = 0 Dexfp * 0.90.02 * Wt Xa − Xmin < (Xmax − Xmin) 147 2(Xmax − Xmin)/3 ≦ Xa − Xb ≦ 0Dexfp = 0 INSfp = 0 Dexfp INSfp Xa − Xmin < (Xmax − Xmin) 148 2(Xmax −Xmin)/3 ≦ 0 < Xa − Xb Dexfp = 0 INSfp = 0 Dexfp 0.02 * Wt Xa − Xmin <(Xmax − Xmin) 149 0 ≦ Xa − Xmax < 10 Xa − Xb ≦ −4 Dexfp = 0 0 < INSfp ≦0.01 * Wt Dexfp INSfp * 0.9 150 0 ≦ Xa − Xmax < 10 Xa − Xb ≦ −4 Dexfp =0 0.1 * Wt < INSfp Dexfp INSfp * 0.95 151 0 ≦ Xa − Xmax < 10 −4 < Xa −Xb ≦ 1 Dexfp = 0 0 < INSfp ≦ 0.02 * Wt Dexfp INSfp * 1.3 152 0 ≦ Xa −Xmax < 10 −4 < Xa − Xb ≦ 1 Dexfp = 0 0.02 * Wt < INSfp ≦ 0.1 * Wt DexfpINSfp * 1.15 153 0 ≦ Xa − Xmax < 10 −4 < Xa − Xb ≦ 1 Dexfp = 0 0.1 * Wt< INSfp Dexfp INSfp * 1.05 154 0 ≦ Xa − Xmax < 10 1 < Xa − Xb Dexfp = 00 < INSfp ≦ 0.01 * Wt Dexfp INSfp * 1.5 155 0 ≦ Xa − Xmax < 10 1 < Xa −Xb Dexfp = 0 0.01 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 1.3 156 0 ≦ Xa −Xmax < 10 1 < Xa − Xb Dexfp = 0 0.1 * Wt < INSfp Dexfp INSfp * 1.1 157 0≦ Xa − Xmax < 10 Xa − Xb ≦ −4 0 < Dexfp ≦ 1/C * Wt 0 < INSfp 0 INSfp 1580 ≦ Xa − Xmax < 10 Xa − Xb ≦ −4 1/C * Wt < Dexfp 0 < INSfp Dexfp * 0.95INSfp * 1.05 159 0 ≦ Xa − Xmax < 10 −4 < Xa − Xb ≦ 0 0 < Dexfp ≦ 1/C *Wt 0 < INSfp 0 INSfp * 1.05 160 0 ≦ Xa − Xmax < 10 −4 < Xa − Xb ≦ 01/C * Wt < Dexfp 0 < INSfp Dexfp * 0.9 INSfp * 1.05 161 0 ≦ Xa − Xmax <10 0 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt 0 < INSfp ≦ 0.01 * Wt 0 INSfp * 1.5162 0 ≦ Xa − Xmax < 10 0 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt 0.01 * Wt <INSfp ≦ 0.1 * Wt 0 INSfp * 1.3 163 0 ≦ Xa − Xmax < 10 0 < Xa − Xb 0 <Dexfp ≦ 1/C * Wt 0.1 * Wt < INSfp 0 INSfp * 1.1 164 0 ≦ Xa − Xmax < 10 0< Xa − Xb 1/C * Wt < Dexfp 0 < INSfp ≦ 0.01 * Wt Dexfp * 0.8 INSfp * 1.5165 0 ≦ Xa − Xmax < 10 0 < Xa − Xb 1/C * Wt < Dexfp 0.01 * Wt < INSfp ≦0.1 * Wt Dexfp * 0.8 INSfp * 1.3 166 0 ≦ Xa − Xmax < 10 0 < Xa − Xb1/C * Wt < Dexfp 0.1 * Wt < INSfp Dexfp * 0.8 INSfp * 1.1 167 0 ≦ Xa −Xmax < 10 Xa − Xb ≦ 0 0 < Dexfp ≦ 1/C * Wt INSfp = 0 0 INSfp 168 0 ≦ Xa− Xmax < 10 Xa − Xb ≦ 0 1/C * Wt < Dexfp INSfp = 0 Dexfp * 0.9 INSfp 1690 ≦ Xa − Xmax < 10 0 < Xa − Xb 0 < Dexfp ≦ 1/C * Wt INSfp = 0 0 0.02 *Wt 170 0 ≦ Xa − Xmax < 10 0 < Xa − Xb 1/C * Wt < Dexfp INSfp = 0 Dexfp *0.8 0.02 * Wt 171 0 ≦ Xa − Xmax < 10 Xa − Xb ≦ −3 Dexfp = 0 INSfp = 0Dexfp INSfp 172 0 ≦ Xa − Xmax < 10 −3 < Xa − Xb Dexfp = 0 INSfp = 0Dexfp 0.02 * Wt 173 10 ≦ Xa − Xmax < 30 Xa − Xb ≦ −6 Dexfp = 0 0 < INSfp≦ 0.1 * Wt Dexfp INSfp * 0.9 174 10 ≦ Xa − Xmax < 30 Xa − Xb ≦ −6 Dexfp= 0 0.1 * Wt < INSfp Dexfp INSfp * 0.95 175 10 ≦ Xa − Xmax < 30 −6 < Xa− Xb ≦ 0 Dexfp = 0 0 < INSfp ≦ 0.02 * Wt Dexfp INSfp * 1.4 176 10 ≦ Xa −Xmax < 30 −6 < Xa − Xb ≦ 0 Dexfp = 0 0.02 * Wt < INSfp ≦ 0.1 * Wt DexfpINSfp * 1.2 177 10 ≦ Xa − Xmax < 30 −6 < Xa − Xb ≦ 0 Dexfp = 0 0.1 * Wt< INSfp Dexfp INSfp * 1.1 178 10 ≦ Xa − Xmax < 30 0 < Xa − Xb Dexfp = 00 < INSfp ≦ 0.02 * Wt Dexfp INSfp * 1.5 179 10 ≦ Xa − Xmax < 30 0 < Xa −Xb Dexfp = 0 0.02 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 1.3 180 10 ≦ Xa− Xmax < 30 0 < Xa − Xb Dexfp = 0 0.1 * Wt < INSfp Dexfp INSfp * 1.1 18110 ≦ Xa − Xmax < 30 Xa − Xb ≦ −6 0 < Dexfp ≦ 2/C * Wt 0 < INSfp 0INSfp * 1.1 182 10 ≦ Xa − Xmax < 30 Xa − Xb ≦ −6 2/C * Wt < Dexfp ≦6/C * Wt 0 < INSfp Dexfp * 0.8 INSfp * 1.1 183 10 ≦ Xa − Xmax < 30 Xa −Xb ≦ −6 6/C * Wt < Dexfp 0 < INSfp Dexfp * 0.9 INSfp * 1.1 184 10 ≦ Xa −Xmax < 30 −6 < Xa − Xb 0 < Dexfp ≦ 2/C * Wt 0 < INSfp ≦ 0.02 * Wt 0INSfp * 1.5 185 10 ≦ Xa − Xmax < 30 −6 < Xa − Xb 0 < Dexfp ≦ 2/C * Wt0.02 * Wt < INSfp ≦ 0.1 * Wt 0 INSfp * 1.3 186 10 ≦ Xa − Xmax < 30 −6 <Xa − Xb 0 < Dexfp ≦ 2/C * Wt 0.1 * Wt < INSfp 0 INSfp * 1.1 187 10 ≦ Xa− Xmax < 30 −6 < Xa − Xb 2/C * Wt < Dexfp 0 < INSfp ≦ 0.02 * Wt Dexfp *0.8 INSfp * 1.5 188 10 ≦ Xa − Xmax < 30 −6 < Xa − Xb 2/C * Wt < Dexfp0.02 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 0.8 INSfp * 1.3 189 10 ≦ Xa − Xmax< 30 −6 < Xa − Xb 2/C * Wt < Dexfp 0.1 * Wt < INSfp Dexfp * 0.8 INSfp *1.1 190 10 ≦ Xa − Xmax < 30 Xa − Xb ≦ 1 0 < Dexfp ≦ 1/C * Wt INSfp = 0 00.03 * Wt 191 10 ≦ Xa − Xmax < 30 Xa − Xb ≦ 1 1/C * Wt < Dexfp INSfp = 0Dexfp * 0.8 0.03 * Wt 192 10 ≦ Xa − Xmax < 30 1 < Xa − Xb 0 < Dexfp ≦1/C * Wt INSfp = 0 0 0.03 * Wt 193 10 ≦ Xa − Xmax < 30 1 < Xa − Xb 1/C *Wt < Dexfp INSfp = 0 Dexfp * 0.7 0.03 * Wt 194 10 ≦ Xa − Xmax < 30 Xa −Xb ≦ −3 Dexfp = 0 INSfp = 0 Dexfp 0.02 * Wt 195 10 ≦ Xa − Xmax < 30 −3 <Xa − Xb Dexfp = 0 INSfp = 0 Dexfp 0.03 * Wt 196 (Xa − Xmax) ≧ 30 Xa − Xb≦ −15 Dexfp = 0 0 < INSfp Dexfp INSfp 197 (Xa − Xmax) ≧ 30 −15 < Xa − XbDexfp = 0 0 < INSfp ≦ 0.02 * Wt Dexfp INSfp * 1.6 198 (Xa − Xmax) ≧ 30−15 < Xa − Xb Dexfp = 0 0.02 * Wt < INSfp ≦ 0.1 * Wt Dexfp INSfp * 1.4199 (Xa − Xmax) ≧ 30 −15 < Xa − Xb Dexfp = 0 0.1 * Wt < INSfp DexfpINSfp * 1.1 200 (Xa − Xmax) ≧ 30 Xa − Xb ≦ −15 0 < Dexfp ≦ 2/C * Wt 0 <INSfp ≦ 0.02 * Wt 0 INSfp * 1.5 201 (Xa − Xmax) ≧ 30 Xa − Xb ≦ −15 0 <Dexfp ≦ 2/C * Wt 0.02 * Wt < INSfp ≦ 0.1 * Wt 0 INSfp * 1.2 202 (Xa −Xmax) ≧ 30 Xa − Xb ≦ −15 0 < Dexfp ≦ 2/C * Wt 0.1 * Wt < INSfp 0 INSfp *1.05 203 (Xa − Xmax) ≧ 30 Xa − Xb ≦ −15 2/C * Wt < Dexfp 0 < INSfp ≦0.02 * Wt Dexfp * 0.9 INSfp * 1.5 204 (Xa − Xmax) ≧ 30 Xa − Xb ≦ −152/C * Wt < Dexfp 0.02 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 0.9 INSfp * 1.2205 (Xa − Xmax) ≧ 30 Xa − Xb ≦ −15 2/C * Wt < Dexfp 0.1 * Wt < INSfpDexfp * 0.9 INSfp * 1.05 206 (Xa − Xmax) ≧ 30 −15 < Xa − Xb 0 < Dexfp ≦2/C * Wt 0 < INSfp ≦ 0.02 * Wt 0 INSfp * 1.7 207 (Xa − Xmax) ≧ 30 −15 <Xa − Xb 0 < Dexfp ≦ 2/C * Wt 0.02 * Wt < INSfp ≦ 0.1 * Wt 0 INSfp * 1.3208 (Xa − Xmax) ≧ 30 −15 < Xa − Xb 0 < Dexfp ≦ 2/C * Wt 0.1 * Wt < INSfp0 INSfp * 1.1 209 (Xa − Xmax) ≧ 30 −15 < Xa − Xb 2/C * Wt < Dexfp 0 <INSfp ≦ 0.02 * Wt Dexfp * 0.8 INSfp * 1.7 210 (Xa − Xmax) ≧ 30 −15 < Xa− Xb 2/C * Wt < Dexfp 0.02 * Wt < INSfp ≦ 0.1 * Wt Dexfp * 0.8 INSfp *1.3 211 (Xa − Xmax) ≧ 30 −15 < Xa − Xb 2/C * Wt < Dexfp 0.1 * Wt < INSfpDexfp * 0.75 INSfp * 1.1 212 (Xa − Xmax) ≧ 30 Xa − Xb ≦ −15 0 < Dexfp ≦1/C * Wt INSfp = 0 0 0.01 * Wt 213 (Xa − Xmax) ≧ 30 Xa − Xb ≦ −15 1/C *Wt < Dexfp INSfp = 0 Dexfp * 0.9 0.01 * Wt 214 (Xa − Xmax) ≧ 30 −15 < Xa− Xb 0 < Dexfp ≦ 2/C * Wt INSfp = 0 0 0.03 * Wt 215 (Xa − Xmax) ≧ 30 −15< Xa − Xb 2/C * Wt < Dexfp INSfp = 0 Dexfp * 0.7 0.03 * Wt 216 (Xa −Xmax) ≧ 30 Xa − Xb ≦ −15 Dexfp = 0 INSfp = 0 Dexfp 0.01 * Wt 217 (Xa −Xmax) ≧ 30 −15 < Xa − Xb Dexfp = 0 INSfp = 0 Dexfp 0.03 * Wt 218 If (Xa≧ (Xmax + 20) mg/dL) and (Xa < Xmax + 50 mg/dL) and Xa − Xb > −5 then(give bolus dose insulin = (0.04 units * Wt) over 10 minutes in additionto INSfn as calculated by algorithm 219 If (Xa ≧ (Xmax + 50) mg/dL) and(Xa < Xmax + 90 mg/dL) and Xa − Xb > −15 then (give bolus dose insulin =(0.04 units * Wt) over 10 minutes in addition to INSfn as calculated byalgorithm 220 If (Xa ≧ Xmax + 90 mg/dL) and Xa − Xb > −20 then (givebolus dose insulin = (0.08 units * Wt) over 10 minutes in addition toINSfn as cal- culated by algorithm 221 If (Dexfn ≧ DexSh) then Dexfn =DexSh and activate alarm “Maximum Dextrose Infusion Rate” 222 If (INSfn≧ INSSh) then INSfn = INSSh and activate alarm “Maximum Insulin InfusionRate” 223 MIVFR = TIVFR − (Dexfn + (INSfn * Conc⁻¹)

Osmolality Algorithm—Definitions and Charactersistes

-   1. Yt=Osmolality value measured at time t with time measured in    seconds-   2. Ya=Average osmolality value measured over previous 10 minutes-   3.    Ya=(Y0+Y30+Y60+Y90+Y120+Y150+Y180+Y210+Y240+Y270+Y300+Y330+Y360+Y390+Y420+Y450+Y480+Y510+Y540+Y570)/20,    whereby these are osmolality values measured every 30 seconds over    the previous 10 minute period-   4. For all values of Yt whereby Yt<Ya−2 standard deviations or >Ya+2    standard deviations, then Yt not included in calculation of Ya-   5. Yb=Average osmolality value measured over 10 minute period    immediately prior to Ya.-   6. OsmSl=Set point for “Low End of Osimolality Range”-   7. OsmSh=Set point for “High End of Osmolality Range”-   8. HTSSh=Set point for “Maximum Hypertonic Saline Infusion Rate”-   9. HTSf=Hypertonic saline flow rate in mL/hour-   10. HTSfp=Hypertonic saline flow rate in mL/hour over previous 10    minutes-   11. HTSfn=Hypertonic saline flow rate in mL/hour over next 10    minutes-   12. Wt Patients weight in Kilograms-   13. On start up initial HTSf set by nurse/physician=HTSfp-   14. Algorithm begins on start up after two average (Ya & Yb)    osmolality values obtained.-   15. Osmolality average values calculated and algorithm adjusts HTSfn    every 10 minutes (12:00, 12:10, 12:20, etc)-   16. Temp=intravascular temperature measured by thermistor-   17. Nurse/Physician selects Hypertonic Saline concentration on start    up (3%, 7.5%, etc) and in calculating initial hypertonic saline    infusion rate entered hypertonic saline concentration number (3,    7.5, etc) is considered variable “Z”.-   18. If OsmSl<270 mOsm/Kg then OsmSl=270 mOsm/Kg-   19. If OsmSh>360 mOsm/Kg then OsmSh=360 mOsm/Kg-   20. If (OsmSh−Osmsl)<10 mOsm/Kg then OsmSl=OsmSh−10 mOsm/Kg-   21. HTSSh=Maximum hypertonic saline rate in mL/hour set by    nurse/physician-   22. MIVFR=Maintenance intravenous fluid rate calculated by algorithm-   23. TIVFR=Total intravenous fluid rate set by nurse/physician-   24. Osmolality algorithm assumes two separate infusions will be used    which will consist of: 1) Hypertonic saline solution, 2) Maintenance    intravenous fluid-   25. Osmolality value as measured by conductivity sensor on catheter    will be calibrated against blood osmolality obtained from patient    and measured in hospital laboratory at least every 12 hours-   26. Alarm “High Osmolality, Hypertonic Saline Off, Assess Patient”    displayed when measured osmolality is >(OsmSh+5 mOsm/Kg) and    Hypertonic Saline flow is zero. Nurse is to assess patient    including: intake & output, insensible fluid losses and composition    of electrolytes in all infused fluids including infused medications

Alarm Events

-   1. “Low Osmolality”—Alarm sounded when measured Osmolality is less    than “Lower Osmolality Alarm Limit” which may be the same or less    than OsmSl. This lower Osmolality alarm limit is set by the    nurse/physician.-   2. “High Osmolality”—Alarm sounded when measured Osmolality is    greater than “Upper Osmolality Alarm Limit” which may be the same or    greater than OsmSh. This upper Osmolality alarm limit is set by the    nurse/physician.-   3. “Maximum Hypertonic Saline Infusion Rate”—Alarm sounded when    HTSfn is greater than HTSSh indicating the algorithm is calling for    a hypertonic saline infusion rate that is greater than the maximal    allowed rate.-   4. “High Osmolality, Hypertonic Saline Off, Assess Patient”—Alarm    sounded when measured Osmolality is >(OsmSh+5 mOsm/Kg) and    Hypertonic Saline flow is zero.-   5. “Check Catheter Position”—Alarm sounded when measured Osmolality    is <“Lower Osmolality Alarm Limit” and temperature is <32 degrees    celcius.

Osmolality Algorithm—User Sets Low & High Osmolality to Determine TargetRange

-   1. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg) and (HTSfp=0    mL/hour) then HTSfn=(0.2*Wt*3/Z) mL/hour-   2. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg) and (HTSfp>0    mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.4)-   3. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg) and    (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.1)-   4. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg) and    (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z; mL/hour) then    HTSfn=(HTSfp*1.05)-   5. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg) and    (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.04)-   6. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=(0.12*Wt*3/Z) mL/hour-   7. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/K) and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.25)-   8. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.07)-   9. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.04)-   10. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.03)-   11. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and (HTSfp=0    mL/hour; then HTSfn=(0.08*Wt*3/Z) mL/hour-   12. If (Ya<OsmSl−5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and (HTSfp>0    mL/hour) then HTSfn=HTSfp-   13. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb<−2 mOsm/Kg)    and (HTSfp=0 mL/hour) then HTSfn=(0.15*Wt*3/Z) mL/hour-   14. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb<−2 mOsm/Kg)    and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.3)-   15. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb<−2 mOsm/Kg)    and (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z) mL/hour)    then HTSfn=(HTSfp*1.07)-   16. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb<−2 mOsm/Kg)    and (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.04)-   37. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb<−2 mOsm/Kg)    and (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.03)-   18. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=(0.08*Wt*3/Z)    mL/hour-   19. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.2)-   20. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mosm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and    (HTSfp≦(0.6*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.05)-   21. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and    (HTSfp≦(1*Wt*3/Z) mL/hour) then HTSfn=: (HTSfp*1.03)-   22. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.02)-   23. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp=0 mL/hour) then HTSfn=HTSfp-   24. If (Ya≧OsmSl−5 mOsm/Kg) and (Ya<OsmSl) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>0 mL/hour) then HTSfn=HTSfp-   25. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=(0.1*Wt*3/Z) mL/hour-   26. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.24)-   27. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.06)-   28. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>(0.6*Wt*3/2) mL/hour) and (HTSfp≦(1*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.03)-   29. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.02)-   30. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb≧−2    mOsm/Kg) and (Ya−Yb<2 mOsm/Kg) and (HTSfp=0 mL/hour; then    HTSfn=(0.06*Wt*3/Z) mL/hour-   31. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb≧−2    mOsm/Kg) and (Ya−Yb<2 mOsm/Kg) and (HTSfp>0 mL/hour) and    (HTSfp≦(0.2*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.15)-   32. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb≧−2    mOsm/Kg) and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and    (HTSfp≦(0.6*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.04)-   33. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb≧−2    mOsm/Kg) and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and    (HTSfp≦(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.02)-   34. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb≧−2    mOsm/Kg) and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.02)-   35. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb≧2    mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=HTSfp-   36. If (Ya≧OsmSl) and (Ya<OsmSl+((OsmSh−OsmSl)/3)) and (Ya−Yb≧2    mOsm/Kg) and (HTSfp>0 mL/hour) then HTSfn=HTSfp-   37. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb<−2 mOsm/Kg) and (HTSfp=0    mL/hour) then HTSfn=(0.07*Wt*3/Z) mL/hour-   38. If (Ya≧OsmSl ((OsmSh−OsmSl)/3)) and (Ya<OsmSl+(2(OsmSh−OsmSl)/3)    and (Ya−Yb<−2 mOsm/Kg) and (HTSfp>0 mL/hour; and (HTSfp≦(0.2*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.2)-   39. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb<−2 mOsm/Kg) and    (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.05)-   40. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb<−2 mOsm/Kg) and    (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z) mL/hour) then    HTSfn (HTSfp*1.03)-   41. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb<−2 mOsm/Kg) and    (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.02)-   42. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=(0.04*Wt*3/Z) mL/hour-   43. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧−2 mosm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.1)-   44. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.03)-   45. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp ((1*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.02)-   46. If (Ya≧OsmSl−((OsmSh−OsmSl)/3)) and (Ya<OsmSl+(2(OsmSh−OsmSl)/3)    and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2 mosm/Kg) and (HTSfp>(1*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.01)-   47. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧2 mOsm/Kg) and (HTSfp=0    mL/hour) then HTSfn=HTSfp-   48. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧2 mOsm/Kg) and (HTSfp>0    mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.8)-   49. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.95)-   50. If (Ya≧OsmSl−((OsmSh−OsmSl)/3)) and (Ya<OsmSl+(2(OsmSh−OsmSl)/3)    and (Ya−Yb≧2 mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and    (HTSfp≦(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.97)-   51. If (Ya≧OsmSl+((OsmSh−OsmSl)/3)) and    (Ya<OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.98)-   52. If (Ya≧OsmSl+(2(Osmsh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=(0.05*Wt*3/Z) mL/hour-   53. If (Ya≧OsmSl+(2(Osmsh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*1.15)-   54. If (Ya≧OsmSl 4 (2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.04)-   55. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*1.02)-   56. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb<−2    mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*1.02)-   57. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb≧−2    mOsm/Kg) and (Ya−Yb<2 mOsm/Kg) then HTSfn=HTSfp-   58. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb≧2    mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=HTSfp-   59. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb≧2    mOsm/Kg) and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.7)-   60. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb≧2    mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*0.92)-   61. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb≧2    mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*0.96)-   62. If (Ya≧OsmSl+(2(OsmSh−OsmSl)/3)) and (Ya<OsmSh) and (Ya−Yb≧2    mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.97)-   63. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg)    then HTSfn=HTSfp-   64. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=HTSfp-   65. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp≧0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*0.85)-   66. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and    (HTSfp≦(0.6*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.96)-   67. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and    (HTSfp≦(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.98)-   68. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg)    and (Ya−Yb<2 mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.98)-   69. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp=0 mL/hour) then HTSfn HTSfp-   70. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.6)-   71. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.9)-   72. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.95)-   73. If (Ya≧OsmSh) and (Ya<OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.96)-   74. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg) and (HTSfp=0    mL/hour) then HTSfn=HTSfp-   75. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb<−2 mOsm/Kg) and (HTSfp>0    mL/hour) then HTSfn=HTSfp-   76. If (Ya≧OsmSh 4 5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp=0 mL/hour) then HTSfn=HTSfp-   77. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>0 mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.86)-   78. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*0.97)-   79. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z)    mL/hour) then HTSfn=(HTSfp*0.99)-   80. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧−2 mOsm/Kg) and (Ya−Yb<2    mOsm/Kg) and (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.99)-   81. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and (HTSfp=0    mL/hour; then HTSfn=HTSfp and activate alarm “High Osmolality,    Hypertonic Saline Off, Assess Patient”-   82. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and (HTSfp>0    mL/hour) and (HTSfp≦(0.2*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.5)-   83. If (Ya≧OsmSh 4 5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(0.2*Wt*3/Z) mL/hour) and (HTSfp≦(0.6*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.87)-   84. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(0.6*Wt*3/Z) mL/hour) and (HTSfp≦(1*Wt*3/Z) mL/hour) then    HTSfn=(HTSfp*0.94)-   85. If (Ya≧OsmSh+5 mOsm/Kg) and (Ya−Yb≧2 mOsm/Kg) and    (HTSfp>(1*Wt*3/Z) mL/hour) then HTSfn=(HTSfp*0.95)-   86. If HTSfn<(0.01*Wt*3/Z) then HTSfn=0 mL/hour-   87. If HTSfn>HTSSh then HTSfn=HTSSh and activate alarm “Maximum    Hypertonic Saline Flow Rate”-   88. MIVFR=(TIVFR−HTSfn)

If Glucose algorithm and Osmolality algorithms are run concurrently theneliminate “223” from Glucose algorithm and replace “88” from Osmolalityalgorithm with:

MIVFR=TIVFR−(Dexfn+(INSfn*Conc⁻¹)+HTSfn)

Osmolality Algorithm Table AND AND Ya Ya − Yb HTSfp HTSfn = (mOsm/Kg)(mOsm/Kg (mL/hr) THEN (mL/hr) 1 Ya − OsmSl < −5 Ya − Yb < −2 HTSfp = 00.2 * Wt * 3/Z 2 Ya − OsmSl < −5 Ya − Yb < −2 0 < HTSfp ≦ 0.2*Wt*3/ZHTSfp * 1.4 3 Ya − OsmSl < −5 Ya − Yb < −2 0.2*Wt*3/Z < HTSfp ≦0.6*Wt*3/Z HTSfp * 1.1 4 Ya − OsmSl < −5 Ya − Yb < −2 0.6*Wt*3/Z < HTSfp≦ 1*Wt*3/Z HTSfp * 1.05 5 Ya − OsmSl < −5 Ya − Yb < −2 1*Wt*3/Z < HTSfpHTSfp * 1.04 6 Ya − OsmSl < −5 −2 ≦ Ya − Yb < 2 HTSfp = 0 0.12 * Wt *3/Z 7 Ya − OsmSl < −5 −2 ≦ Ya − Yb < 2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp *1.25 8 Ya − OsmSl < −5 −2 ≦ Ya − Yb < 2 0.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/ZHTSfp * 1.07 9 Ya − OsmSl < −5 −2 ≦ Ya − Yb < 2 0.6*Wt*3/Z < HTSfp ≦1*Wt*3/Z HTSfp * 1.04 10 Ya − OsmSl < −5 −2 ≦ Ya − Yb < 2 1*Wt*3/Z <HTSfp HTSfp * 1.03 11 Ya − OsmSl < −5 2 ≦ Ya − Yb HTSfp = 0 0.08 * Wt *3/Z 12 Ya − OsmSl < −5 2 ≦ Ya − Yb 0 < HTSfp HTSfp 13 −5 ≦ Ya − OsmSl <0 Ya − Yb < −2 HTSfp = 0 0.15 * Wt * 3/Z 14 −5 ≦ Ya − OsmSl < 0 Ya − Yb< −2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 1.3 15 −5 ≦ Ya − OsmSl < 0 Ya − Yb <−2 0.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/Z HTSfp * 1.07 16 −5 ≦ Ya − OsmSl < 0Ya − Yb < −2 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 1.04 17 −5 ≦ Ya −OsmSl < 0 Ya − Yb < −2 1*Wt*3/Z < HTSfp HTSfp * 1.03 18 −5 ≦ Ya − OsmSl< 0 −2 ≦ Ya − Yb < 2 HTSfp = 0 0.08 * Wt * 3/Z 19 −5 ≦ Ya − OsmSl < 0 −2≦ Ya − Yb < 2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 1.2 20 −5 ≦ Ya − OsmSl < 0−2 ≦ Ya − Yb < 2 0.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/Z HTSfp * 1.05 21 −5 ≦ Ya− OsmSl < 0 −2 ≦ Ya − Yb < 2 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 1.0322 −5 ≦ Ya − OsmSl < 0 −2 ≦ Ya − Yb < 2 1*Wt*3/Z < HTSfp HTSfp * 1.02 23−5 ≦ Ya − OsmSl < 0 2 ≦ Ya − Yb HTSfp = 0 HTSfp 24 −5 ≦ Ya − OsmSl < 0 2≦ Ya − Yb 0 < HTSfp HTSfp 25 0 ≦ Ya − OsmSl < (OsmSh − OsmSl)/3 Ya − Yb< −2 HTSfp = 0 0.1 * Wt * 3/Z 26 0 ≦ Ya − OsmSl < (OsmSh − OsmSl)/3 Ya −Yb < −2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 1.24 27 0 ≦ Ya − OsmSl < (OsmSh −OsmSl)/3 Ya − Yb < −2 0.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/Z HTSfp * 1.06 28 0≦ Ya − OsmSl < (OsmSh − OsmSl)/3 Ya − Yb < −2 0.6*Wt*3/Z < HTSfp ≦1*Wt*3/Z HTSfp * 1.03 29 0 ≦ Ya − OsmSl < (OsmSh − OsmSl)/3 Ya − Yb < −21*Wt*3/Z < HTSfp HTSfp * 1.02 30 0 ≦ Ya − OsmSl < (OsmSh − OsmSl)/3 −2 ≦Ya − Yb < 2 HTSfp = 0 0.006 * Wt * 3/Z 31 0 ≦ Ya − OsmSl < (OsmSh −OsmSl)/3 −2 ≦ Ya − Yb < 2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 1.15 32 0 ≦ Ya− OsmSl < (OsmSh − OsmSl)/3 −2 ≦ Ya − Yb < 2 0.2*Wt*3/Z < HTSfp ≦0.6*Wt*3/Z HTSfp * 1.04 33 0 ≦ Ya − OsmSl < (OsmSh − OsmSl)/3 −2 ≦ Ya −Yb < 2 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 1.02 34 0 ≦ Ya − OsmSl <(OsmSh − OsmSl)/3 −2 ≦ Ya − Yb < 2 1*Wt*3/Z < HTSfp HTSfp * 1.02 35 0 ≦Ya − OsmSl < (OsmSh − OsmSl)/3 2 ≦ Ya − Yb HTSfp = 0 HTSfp 36 0 ≦ Ya −OsmSl < (OsmSh − OsmSl)/3 2 ≦ Ya − Yb 0 < HTSfp HTSfp 37 (OsmSh −OsmSl)/3 ≦ Ya − OsmSl < 2 Ya − Yb < −2 HTSfp = 0 0.07 * Wt * 3/Z (OsmSh− OsmSl)/3 38 (OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 Ya − Yb < −2 0 < HTSfp≦ 0.2*Wt*3/Z HTSfp * 1.2 (OsmSh − OsmSl)/3 39 (OsmSh − OsmSl)/3 ≦ Ya −OsmSl < 2 Ya − Yb < −2 0.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/Z HTSfp * 1.05(OsmSh − OsmSl)/3 40 (OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 Ya − Yb < −20.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 1.03 (OsmSh − OsmSl)/3 41 (OsmSh −OsmSl)/3 ≦ Ya − OsmSl < 2 Ya − Yb < −2 1*Wt*3/Z < HTSfp HTSfp * 1.02(OsmSh − OsmSl)/3 42 (OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 −2 ≦ Ya − Yb < 2HTSpf = 0 0.05 * Wt *3/Z (OsmSh − OsmSl)/3 43 (OsmSh − OsmSl)/3 ≦ Ya −OsmSl < 2 −2 ≦ Ya − Yb < 2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 1.1 (OsmSh −OsmSl)/3 44 (OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 −2 ≦ Ya − Yb < 20.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/Z HTSfp * 1.03 (OsmSh − OsmSl)/3 45 (OsmSh− OsmSl)/3 ≦ Ya − OsmSl < 2 −2 ≦ Ya − Yb < 2 0.6*Wt*3/Z < HTSfp ≦1*Wt*3/Z HTSfp * 1.02 (OsmSh − OsmSl)/3 46 (OsmSh − OsmSl)/3 ≦ Ya −OsmSl < 2 −2 ≦ Ya − Yb < 2 1*Wt*3/Z < HTSfp HTSfp * 1.01 (OsmSh −OsmSl)/3 47 (OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 2 ≦ Ya − Yb HTSfp = 0HTSfp (OsmSh − OsmSl)/3 48 (OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 2 ≦ Ya −Yb 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 0.08 (OsmSh − OsmSl)/3 49 (OsmSh −OsmSl)/3 ≦ Ya − OsmSl < 2 2 ≦ Ya − Yb 0.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/ZHTSfp * 0.95 (OsmSh − OsmSl)/3 50 (OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 2 ≦Ya − Yb 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 0.97 (OsmSh − OsmSl)/3 51(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 2 ≦ Ya − Yb 1*Wt*3/Z < HTSfp HTSfp *0.98 (OsmSh − OsmSl)/3 52 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < Ya − Yb < −2HTSfp = 0 0.05 * Wt * 3/Z OsmSh − OsmSl 53 2(OsmSh − OsmSl)/3 ≦ Ya −OsmSl < Ya − Yb < −2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 1.15 OsmSh − OsmSl54 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < Ya − Yb < −2 0.2*Wt*3/Z < HTSfp ≦0.6*Wt*3/Z HTSfp * 1.04 OsmSh − OsmSl 55 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl< Ya − Yb < −2 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 1.02 OsmSh − OsmSl56 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < Ya − Yb < −2 1*Wt*3/Z < HTSfpHTSfp * 1.02 OsmSh − OsmSl 57 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < −2 ≦ Ya− Yb < 2 — HTSfp OsmSh − OsmSl 58 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 ≦Ya − Yb HTSfp = 0 HTSfp OsmSh − OsmSl 59 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl< 2 ≦ Ya − Yb 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 0.7 OsmSh − OsmSl 602(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 ≦ Ya − Yb 0.2*Wt*3/Z < HTSfp ≦0.6*Wt*3/Z HTSfp * 0.92 OsmSh − OsmSl 61 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl< 2 ≦ Ya − Yb 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 0.96 OsmSh − OsmSl62 2(OsmSh − OsmSl)/3 ≦ Ya − OsmSl < 2 ≦ Ya − Yb 1*Wt*3/Z < HTSfpHTSfp * 0.97 OsmSh − OsmSl 63 (OsmSh − OsmSl) ≦ Ya − OsmSl < Ya − Yb <−2 — HTSfp (OsmSh − OsmSl) + 5 64 (OsmSh − OsmSl) ≦ Ya − OsmSl < −2 ≦ Ya− Yb < 2 HTSfp = 0 HTSfp (OsmSh − OsmSl) + 5 65 (OsmSh − OsmSl) ≦ Ya −OsmSl < −2 ≦ Ya − Yb < 2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 0.85 (OsmSh −OsmSl) + 5 66 (OsmSh − OsmSl) ≦ Ya − OsmSl < −2 ≦ Ya − Yb < 2 0.2*Wt*3/Z< HTSfp ≦ 0.6*Wt*3/Z HTSfp * 0.96 (OsmSh − OsmSl) + 5 67 (OsmSh − OsmSl)≦ Ya − OsmSl < −2 ≦ Ya − Yb < 2 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp *0.98 (OsmSh − OsmSl) + 5 68 (OsmSh − OsmSl) ≦ Ya − OsmSl < −2 ≦ Ya − Yb< 2 1*Wt*3/Z < HTSfp HTSfp * 0.98 (OsmSh − OsmSl) + 5 69 (OsmSh − OsmSl)≦ Ya − OsmSl < 2 ≦ Ya − Yb HTSfp = 0 HTSfp (OsmSh − OsmSl) + 5 70 (OsmSh− OsmSl) ≦ Ya − OsmSl < 2 ≦ Ya − Yb 0 < HTSfp ≦ 0.2*Wt*3/Z HTSfp * 0.6(OsmSh − OsmSl) + 5 71 (OsmSh − OsmSl) ≦ Ya − OsmSl < 2 ≦ Ya − Yb0.2*Wt*3/Z < HTSfp ≦ 0.6*Wt*3/Z HTSfp * 0.9 (OsmSh − OsmSl) + 5 72(OsmSh − OsmSl) ≦ Ya − OsmSl < 2 ≦ Ya − Yb 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/ZHTSfp * 0.95 (OsmSh − OsmSl) + 5 73 (OsmSh − OsmSl) ≦ Ya − OsmSl < 2 ≦Ya − Yb 1*Wt*3/Z < HTSfp HTSfp * 0.96 (OsmSh − OsmSl) + 5 74 (OsmSh −OsmSl) + 5 ≦ Ya − OsmSl Ya − Yb < −2 HTSfp = 0 HTSfp 75 (OsmSh −OsmSl) + 5 ≦ Ya − OsmSl Ya − Yb < −2 HTSfp > 0 HTSfp 76 (OsmSh −OsmSl) + 5 ≦ Ya − OsmSl −2 ≦ Ya − Yb < 2 HTSfp = 0 HTSfp 77 (OsmSh −OsmSl) + 5 ≦ Ya − OsmSl −2 ≦ Ya − Yb < 2 0 < HTSfp ≦ 0.2*Wt*3/Z HTSft *0.86 78 (OsmSh − OsmSl) + 5 ≦ Ya − OsmSl −2 ≦ Ya − Yb < 2 0.2*Wt*3/Z <HTSfp ≦ 0.6*Wt*3/Z HTSfp * 0.97 79 (OsmSh − OsmSl) + 5 ≦ Ya − OsmSl −2 ≦Ya − Yb < 2 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 0.99 80 (OsmSh −OsmSl) + 5 ≦ Ya − OsmSl −2 ≦ Ya − Yb < 2 1*Wt*3/Z < HTSfp HTSfp * 0.9981 (OsmSh − OsmSl) + 5 ≦ Ya − OsmSl 2 ≦ Ya − Yb HTSfp = 0 HTSfp ALARM 82(OsmSh − OsmSl) + 5 ≦ Ya − OsmSl 2 ≦ Ya − Yb 0 < HTSfp ≦ 0.2*Wt*3/ZHTSfp * 0.5 83 (OsmSh − OsmSl) + 5 ≦ Ya − OsmSl 2 ≦ Ya − Yb 0.2*Wt*3/Z <HTSfp ≦ 0.6*Wt*3/Z HTSfp * 0.87 84 (OsmSh − OsmSl) + 5 ≦ Ya − OsmSl 2 ≦Ya − Yb 0.6*Wt*3/Z < HTSfp ≦ 1*Wt*3/Z HTSfp * 0.94 85 (OsmSh − OsmSl) +5 ≦ Ya − OsmSl 2 ≦ Ya − Yb 1*Wt*3/Z < HTSfp HTSfp * 0.95 86 If HTSfn <(0.01 * Wt * 3/Z) then HTSfn = 0 mL/hour 87 If HTSfn > HTSSh then HTSfn= HTSSh and activate Alarm “Maximum Hypertonic Saline Flow Rate” 88MIVFR = (TIVFR − HTSfn) If Glucose algorithm and Osmolality algorithmare run concurrently then eliminate “223” from Glucose algorithm andreplace “88” from Osmolality algorithm with: MIVFR = TIVFR − (Dexfn +(INSfn * Conc − 1) + HTSfn)

Rules for Secondary Controller

-   1. If (Xmin≧80 mg/dL) and (Xa<Xmin) and (Xa−Xb≦−6 mg/dL) then    INSfn_(2c)=(INSfn*0.75)-   2. If (Xa<Xmin) and (Xa−Xb≦−6 mg/dL) and (Dexfp>0 mL/hour) then    Dexfn_(2c)=(Dexfn*1.2)-   3. If (Xa<60 mg/dL) and (INSfn≧0 units/hour) then INSfn_(2c)=0    units/hour-   4. If (Xa>60 mg/dL) and (Xa<70 mg/dL) and (Xa−Xb>−10 mg/dL) and    (Xa−Xb<−5 mg/dL) and (INSfn≧0 units/hour) then    INSfn_(2c)=(INSfn*0.8)-   5. If (Xa>60 mg/dL) and (Xa<70 mg/dL) and (Xa−Xb<−10 mg/dL) and    (INSfn≧0 units/hour) then INSfn_(2c)=0 units/hour-   6. If (Xa>Xmin) and (Xa<Xmax) and (Xa−Xb<−8 mg/dL) then    INSfn_(2c)=(INSfn*0.8)-   7. If (Xa>Xmin) and (Xa<Xmax) and (Xa−Xb≧10 mg/dL) and (Xa−Xb<15    mg/dL) then INSfn_(2c)=(INSfn*1.1)-   8. If (Xa>Xmin) and (Xa<Xmax) and (Xa−Xb≧15 mg/dL) then    INSfn_(2c)=(INSfn*1.2)-   9. If (Xa<100 mg/dL) and (Xa−Xb<−12 mg/dL) and (Dexfn=0 mL/hour)    then Dexfn_(2c)=(2/C*Wt) mL/hour-   10. If (Xa>Xmin) and (Xa<Xmax) and (Xa−Xb<−12 mg/dL) and (Dexfn>0    mL/hour) then Dexfn_(2c)=(Dexfn*1.2)-   11. If (Xa>Xmin) and (Xa−Xb≧10 mg/dL) and (Dexfn>0 mL/hour) then    Dexfn_(2c)=(Dexfn*0.8)-   12. If (Xa>Xmax) and (Xa<Xmax+30 mg/dL) and (Xa−Xb≧−20 mg/dL) and    (Xa−Xb<−10 mg/dL) and (no bolus given) then INSfn_(2c)=(INSfn*0.75)-   13. If (Xa>Xmax) and (Xa<(Xmax+30 mg/dL)) and (Xa−Xb<−20 mg/dL) and    (Xa−Xc<−30 mg/dL) then INSfn_(2c)=(INSfn*0.65)-   14. If (Xa>Xmax) and (Xa−Xb≧10 mg/dL) and (INSfn<(0.08*Wt)    units/hour) then INSfn_(2c)=(INSfn*1.3)-   15. If (Xa>Xmax) and (Xa−Xb≧10 mg/dL) and (INSfn≧(0.08*Wt)    units/hour) then INSfn_(2c)=(INSfn*1.1)-   16. If (Xa>(Xmax+30 mg/dL)) and (Xa≦(Xmax+60 mg/dL)) and (Xa−Xb<−20    mg/dL) then INSfn_(2c)=(INSfp*0.7)-   17. If (Xa>(Xmax+30 mg/dL)) and (Xa≦(Xmax+60 mg/dL)) and (Xa−Xb>−20    mg/dL) and (Xa−Xb<−15 mg/dL) then INSfn_(2c)=(INSfn*0.75)-   18. If (Xa>(Xmax+30 mg/dL)) and (Xa≦(Xmax+60 mg/dL)) and (Xa−Xb>−15    mg/dL) and (Xa−Xb<−10 mg/dL) then INSfn_(2c)=INSfp-   19. If (Xa>(Xmax+60 mg/dL)) and (Xa−Xb<−20 mg/dL) and (Xa−Xc<−40    mg/dL) then INSfn_(2c)=(INSfn*0.65)-   20. If (Xa<Xmin) then change algorithm cycle interval to every 5    minutes-   21. If (Xa>(Xmin) and (Xa<Xmax) and (Xa−Xb≦−10 mg/dL) then change    algorithm cycle interval to every 5 minutes-   22. If (Xa>(Xmin) and (Xa<Xmax) and (Xa−Xb≧10 mg/dL) then change    algorithm cycle interval to every 5 minutes-   23. If (Xa>Xmax) and (Xa<Xmax+30 mg/dL) and (Xa−Xb<−10 mg/dL) then    change cycle interval to every 5 minutes-   24. If (Xa>(Xmax+30 mg/dL)) and (Xa−Xb<−20 mg/dL) then change    algorithm cycle interval to every 5 minutes-   25. If (Xa>Xmin) and (Xa<Xmax) and (Xa−Xb>−10 mg/dL) and (Xa−Xb<10    mg/dL) then cycle interval=every 10 minutes-   26. If (Xa>Xmax) and (Xa<(Xmax+30 mg/dL)) and (Xa−Xb≧−10 mg/dL) then    cycle interval=every 10 minutes-   27. If (Xa>(Xmax+30 mg/dL)) and (Xa−Xb>−20 mg/dL) then cycle    interval=: every 10 minutes-   28. Secondary controller rules modify rules 1-217, but do not modify    rules 218-220.

1. A computerized osmolality adjustment system for intravenouslycontrolling a patient's blood osmolality on a real time basis, saidsystem comprising: a catheter placed within the patient's venous system;a conductivity sensor assembly attached to said catheter and in directcontact with the patient's bloodstream; a pump connected to a fluidsource for infusing said fluid into a patient's bloodstream through saidcatheter; a computer processor in electronic communication with saidconductivity sensor assembly to convert blood conductivity into anosmolality measurement, wherein the processor is also in electroniccommunication with said pump; a fluid infusion control module stored insaid processor for controlling the pumped fluid flow rate, wherein saidfluid infusion control module comprises pump controlling commands to (i)determine where the patient's real time average osmolality lies along acontinuum of osmolality values; (ii) track the rate at which the bloodosmolality is changing over time; and (iii) iteratively adjust the pumpoutput so that the fluid flow rate into the patient's body adjusts theaverage osmolality level closer to a known normal range.
 2. Acomputerized osmolality adjustment system according to claim 1, whereinsaid fluid is hypertonic saline.
 3. A computerized osmolality adjustmentsystem according to claim 1, wherein said fluid infusion control moduleconverts the conductivity measurement to an osmolality measurement usingthe formulaSerum Osmolality=18.95 (mOsm/mSiemen)×measured conductivity (mSiemen).4. A computerized osmolality adjustment system according to claim 3,wherein a user sets the known normal range for blood osmolality betweenOsmSl and OsmSh.
 5. A computerized osmolality adjustment systemaccording to claim 4, wherein said fluid infusion control modulecalculates and stores an average blood osmolality level Ya over aspecified time period.
 6. A computerized osmolality adjustment systemaccording to claim 2, wherein said fluid infusion control modulecalculates and stores blood osmolality value Yt every 30 seconds andcalculates the average osmolality level Ya over said specified timeperiod equal to 10 minutes.
 7. A computerized osmolality adjustmentsystem according to claim 2, wherein said pump controlling commands aredivided into categories defined by osmolality value ranges along saidosmolality value continuum.
 8. A computerized osmolality adjustmentsystem according to claim 7, wherein said controller calculates thecategory for the current average osmolality measurement Ya.
 9. Acomputerized osmolality adjustment system, according to claim 2, whereinsaid pump controlling command category is selected from the groupconsisting of the following where Ya is the most recently calculatedaverage blood osmolality, OsmSl is the lowest acceptable value for bloodosmolality, and OsmSh is the highest acceptable value for bloodosmolality: Category 1: Ya−OsmSl<−5 mOsm/Kg Category 2: −5 Ya−OsmSl<0mOsm/Kg Category 3: 0≦Ya−OsmSl<(OsmSh−OsmSl)/3 mOsm/Kg Category 4:(OsmSh−OsmSl)/3≦Ya−OsmSl<2(OsmSh−OsmSl)/3 mOsm/Kg Category 5:2(OsmSh−OsmSl)/3≦Ya−OsmSl<OsmSh−OsmSl mOsm/Kg Category 6:OsmSh−OsmSl≦Ya−OsmSl<(OsmSh−OsmSl)+5 mOsm/Kg Category 7:OsmSh−OsmSl)+5≦Ya−OsmSl mOsm/Kg
 10. A computerized osmolality adjustmentsystem according to claim 9, wherein said controller compares saidcurrent osmolality measurement Ya to a prior average osmolalitymeasurement Yb to determine the rate at which the osmolality level ischanging.
 11. A computerized osmolality adjustment system according toclaim 9, wherein said infused fluid is hypertonic saline and whereinsaid pump controlling commands adjust the flow rate of hypertonic salineby an adjustment factor defined by the category in which the currentosmolality measurement fits and the rate at which the osmolality levelis changing.
 12. A computerized osmolality adjustment system accordingto claim 11, wherein for each category, the next saline flow rate isadjusted for condition Ya−Yb, wherein said condition is selected fromthe group consisting of Ya−Yb<−2; 2>Ya−Yb≦−2; and Ya−Yb≧2.
 13. Acomputerized osmolality adjustment system according to claim 12, whereinsaid pump controlling commands adjust said next saline flow rate as afunction of the previous saline flow rate within said specified timeperiod.
 14. A computerized osmolality adjustment system according toclaim 13, wherein said previous saline flow rate is selected from thegroup consisting of: (i) HTSfp=0 mL/hour; (ii) 0mL/hour<HTSfp≦(0.2*Wt*3/Z) mL/hour; (iii) (0.2*Wt*3/Z)mL/hour<HTSfp≦(0.6*Wt*3/Z) mL/hour (iv) (0.6*Wt*3/Z)mL/hour<HTSfp≦(1.0*Wt*3/Z) mL/hour; (v) HTSfp>(1*Wt*3/Z) mL/hour;wherein Z is the initial concentration of saline in percentweight/volume, and HTSfp is the past flow of saline into the patient andWt is the patient's weight in kilograms.
 15. A computerized osmolalityadjustment system according to 14, wherein said fluid infusion controlmodule operates continuously on a real time basis with updatedconductivity measurements from said conductivity sensor on saidcatheter.
 16. A computerized method of adjusting a patient's bloodosmolality on a real time basis by adjusting the saline flow to thepatient, the method comprising: continuously measuring the patient'sreal time blood osmolality; storing each real time blood osmolalityvalue in a computer processor; calculating via the computer processorthe average blood osmolality, Ya, over a specified time period;electronically assigning the average osmolality level to one of a seriesof osmolality control ranges; calculating the rate at which the averageblood osmolality level changes from one of said specified time periodsto the next; determining the saline flow adjustment factor necessary foran average osmolality level in an assigned control range changing at acalculated rate.
 17. A computerized method according to claim 16,further comprising the step of multiplying the current saline flow rateby respective adjustment factors.
 18. A computerized method according toclaim 17, wherein the saline adjustment factor is selected from thegroup consisting of 0, 0.5, 0.6, 0.7, 0.8, 0.85, 0.86, 0.87, 0.9, 0.92,0.94, 0.95, 0.96, 0.97, 0.98, 0.99, 1.0, 1.01, 1.02, 1.03, 1.04, 1.05,1.06, 1.07, 1.1, 1.15, 1.2, 1.24, 1.25, 1.3, 1.4
 19. A computerizedmethod according to claim 18, further comprising the step of adjustingthe saline flow rate to a flow rate greater than zero.
 20. Acomputerized method according to claim 19, further comprising the stepof setting the values of the initial saline flow rate manually prior tothe step of continuously measuring the patient's real time osmolalitylevel.